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GROUP PSYCHOTHERAPY
A SYMPOSIUM
Copyright Beacon House, New York, 1945
For subscribers of "Sociometry" and members of the American Sociometric
Association, this publication represents Vol. VIII, No's. 3 and 4.
Published quarterly by Beacon House, Inc., at Beacon, N. Y., hi February, May, August
and November. Address all communications to: Beacon House, Inc., Beacon, N. Y,, or
101 Park Avenue, New York 17, N. Y. Re-entered as second class matter, October, 1943,
at the Post Office at Beacon, New York, under the act of March 31, 1879.
CONTENTS
AUTHOR'S BIOGRAPHIES 5
ACKNOWLEDGMENTS ;W..-V. ^,1 ... .'....,. , ,.,...' 11
FOREWORD Winfred Overholser 13
CONFERENCE ON GROUP METHOD, 1932
THE APPLICATION OF THE GROUP METHOD TO THE CLASSIFICATION
OF PRISONERS William A. White, Chairman; Speakers, Vernon C.
Branham; Amos T. Baker; Fannie French Morse; Julia K.
Jaffray; Franz Alexander; Wm. J. Ellis; F. Lovell Bixby; Edgar
A. Doll; Q. Holsopple; Paul L. Schroeder; Ellen C. Potter;
Benjamin Karpman; S. W. Hartwell; E. Stagg Whitin; J. L.
Moreno IS
CONFERENCE ON GROUP PSYCHOTHERAPY, 1944
INTRODUCTORY REMARKS Roscoe W. Hall, Chairman 41
GROUP PSYCHOTHERAPY Francis J. Braceland 45
GROUP PSYCHOTHERAPY AND THE PSYCHODRAMATIC METHOD Bruno
Solby 50
SOME USES OF PSYCHODRAMA AT ST. ELIZABETHS HOSPITAL Frances
Herriott 54
PSYCHODRAMA IN A CHILD GUIDANCE CLINIC Louise A. Sullivan ... 58
GROUP PSYCHOTHERAPY Samuel B. Hadden 68
VISUAL AIDS IN GROUP PSYCHOTHERAPY: PUPPETRY R. Robert
Cohen 73
SCIENTIFIC FOUNDATIONS OF GROUP PSYCHOTHERAPY J. L. Moreno 77
LECTURE METHODS
THE GROUP METHOD IN THE TREATMENT OF PSYCHOSOMATIC DIS-
ORDERS Joseph H. Pratt 85
THE COMBINED SYSTEM OF GROUP PSYCHOTHERAPY AND SELF-HELP
AS PRACTICED BY RECOVERY, INC. Abraham. A. Low 94
ANALYTICAL GTS r r M FTHODS
GROUP PSYOET /: i ;.,'-: \ > 7- -L. '* r . Lazell 101
GROUP Psy {-. f . r -Li- ''/, -Vender 108
NEWER T > ;// , v : > v : . ^ICATION AND RESEARCH OF GROUP
p ; , , , ;.::-, " J : -.r Eliasberg 112
Sew 1 1; 1 - . iV ,- v " ' ; OF GROUP PSYCHOTHERAPY Nathan W.
V^^,: 117
PSYCBODRAMATIC METHODS
f SYCHODRAMA'IN AN EVACUATION HOSPITAL Ernest Fantel 125
PsYCHpiliA^ATic TECHNIQUE AS A TEACHING DEVICE Margaret
HA&N ; AND EDITH WRIGHT 146
SPONTANEITY TRAINING OF THE FEEBLE-MINDED Theodore R.
Sarbin 1S1
PATIENTS AS THERAPEUTIC AGENTS IN A MENTAL HOSPITAL Gerhard
Schauer 156
DRAMA THERAPY Lewis Barbato 158
SOCIODRAMA
A SOCIODRAMATIC AUDIENCE TEST Zerka Toeman 161
ROLE-PLAYING AS A METHOD OF TRAINING FOREMEN John R, P.
French 172
, ROLE TESTS AND ROLE DIAGRAMS OF CHILDREN Florence B. Moreno
and J, L. Moreno 188
SOCIOMETRIC METHODS
SOME APPROACHES TO GROUP PROBLEMS IN THE BRITISH ARMY
J. D. Sutherland and G. A. Fitzpatrick 205
THE WARMING UP PROCESS OF AN AUDIENCE Paul Cornyetz 218
MUSICAL METHODS
THE ORGANISM-AS-A-WHOLE AND Music THERAPY Ira M. Altshuler 227
Music IN THE TREATMENT OF CONVALESCENTS Leila A. McKay . . 233
NOTE ON PSYCHOMUSIC AND MUSICAL GROUP PSYCHOTHERAPY
Milton EL Ward 238
DANCE METHODS
RHYTHM IN MOVEMENT AS USED IN ST. ELIZABETHS HOSPITAL
Marian Chace , 243
MOTION PICTURE METHODS
THERAPEUTIC FILMS AND GROUP PSYCHOTHERAPY Howard P. Rome 247
AUDIENCE REACTIONS TO THERAPEUTIC FILMS Zerka Toeman .... 255
HISTORICAL SURVEY
ORIGINS AND DEVELOPMENT OF GROUP PSYCHOTHERAPY Joseph I.
Meiers 261
THE FUTTOE OF MAN'S WORLD]. L. Moreno 297
SUBJECT'S INDEX 305
IN MEMORIAM BRUNO SOLBY Margaret Hagan 310
IN MEMORIAM WILLARD WALLER Ruth Mallay 312
ANNOUNCEMENTS 314
AMERICAN SOCIOMETRIC ASSOCIATION 316
PSYCHODRAMATIC INSTITUTE PROGRAM 1946 321
STATEMENT OF OWNERSHIP 324
AUTHORS' BIOGRAPHIES
Winjred Overholser
Boston University, M.D., 1916; Commissioner of Mental Disease, State of
Massachusetts, 1934-1936; Superintendent, St. Elizabeths Hospital, Wash-
ington, D. C.; Professor of Psychiatry, George Washington University,
School of Medicine; published "The Desiderata of Central Administrative
Control of State Mental Hospitals," American Journal of Psychiatry, Vol-
ume 96, Number 3, November 1939; President-Elect, American Psychiatric
Association, 1946-1947.
William Alanson White
(Late) Superintendent of St. Elizabeths Hospital, Washington, D. C.
Vernon C. Branham
University of Colorado, M.D., 1919; Deputy Commissioner of Correction,
New York State, in charge of Psychiatric Service 'in Prisons, 1930-1935;
Superintendent, Woodbourne Institution of Defective Delinquents, Wood-
bourne, N. Y.; Publisher and Editor, Journal of Clinical Psychopathology;
published "The Classification and Treatment of the Defective Delinquent,"
Journal of Criminal Law and Criminology, Volume 17.
Amos T. Baker
University of Buffalo, M.D., 1897; Director of Classification, Sing Sing
Prison Psychiatric Clinic 1927-1939,
Fannie French Morse
(Late) Superintendent, New York State Training School for Girls, Hudson,
New York.
Julia K. Jaffray
(Late) Secretary, National Commission on Prisons and Prison Labor.
Franz Alexander
University of Budapest, M.D., 1912; Director, Institute for Psycho-
analysis, Chicago, Illinois; Associate Professor of Psychiatry, University
of Illinois, Medical School; published "The Medical Value of Psycho-
analysis," 1932, "The Criminal, the Judge and the Public," 1930.
Wittiam 7. Ellis
(Late) Commissioner of Institutions and Agencies, State of New Jersey.
S
243
244 GROUP PSYCHOTHERAPY
F. Lovett Bixby
Assistant Director, Division of Classification, Department of Institutions
and Agencies, Trenton, New Jersey.
Edgar A. Dott
Princeton University, Ph.D., 1920; Chief Psychologist, Training School,
Vineland, New Jersey; published "Mental Deficiency Due to Birth Injuries"
(with W. M. Phelps and R. T. Melcher), 1932.
James Q. Holsoppk
Chief Clinical Psychologist, New Jersey State Hospital, Trenton, New
Jersey; Consulting Editor, Journal of Abnormal and Social Psychology.
Paul L. Sckroeder
University of Illinois, M.D., 1919; Director, Institute for Juvenile Re-
search; published "Child Guidance Procedure," (Co-Author); Active duty,
Medical Corps, Army of the United States, Consultant in Neuropsychiatry,
Fourth Service Command, Atlanta, Georgia.
Ellen C. Potter
(Late) Director of Medicine, New Jersey Department of Institutions
and Agencies.
Benjamin Karpman
University of Minnesota, M.D., 1920; Senior Medical Officer, St. Eliza-
beths Hospital, Washington, D. C.
S. W. Hartwell
University of Iowa, M.D., 1906; Chief of Staff, Neuropsychiatric Depart-
ment, Edward J. Meyer Hospital, Buffalo, New York; published "Social
Psychiatry Our Torch or a New Profession," American Journal of Psychia-
try, March 1940.
E. Stagg Wkitin
Columbia University, Ph.D.; Chairman Executive Council of the National
Committee on Prisons and Prison Labor; published "Penal Servitude."
/, L. Moreno
University of Vienna, MJX, 1917; Physician in Charge, Beacon Hill
Sanitarium, Beacon, N. Y.; Chairman, Editorial Board, Sociometry, A
Journal of Inter-Personal Relations, New York City.
AUTHORS' BIOGRAPHIES 245
Roscoe W. Hall
Johns Hopkins University, M.D., 1912; Director of Clinical Psychiatry,
St. Elizabeths Hospital, Washington, D. C.; Professor of Psychiatry, George
Washington University, Medical School; published "The Organization of
Psychotherapy," American Journal of Psychiatry, Volume 13, November
1933.
Francis J. Bracdond
Jefferson Medical School, M.D., 1930; Dean, School of Medicine and
Professor of Psychiatry, Loyola University, Chicago, 1941-1942; Active duty,
Medical Corps, U. S. Naval Reserve, 1942; On duty, Chtef of Neuropsy-
chiatry Branch, Professional Division,- Bureau of Medicine and Surgery.
Bruno Solby
University of Vienna, M.D., 1932; Psychiatrist in Charge, Employees
Mental Hygiene Unit, United States Public Health Service, Washington, D. C.
Frances Herriott
Drake University, A,B.; formerly Stage Manager with The Theatre Guild
and Director of west coast production of Porgy and Bess; Psychodrainatic
Institute, Beacon, N. Y., 1940; Director of Psychodrama at St. Elizabeths
Hospital, Washington, D, C.
Louise A. Sullivan
Formerly Assistant in Psychiatry, Duke University Hospital.
Samuel B. Hadden
University of Pennsylvania, M.D., 1924; Assistant Professor of Neurolo-
gy, School of Medicine, University of Pennsylvania.
R. Robert Cohen
University of Pittsburgh, M.D., 1932; Active duty, Army of the United
States, Medical Reserve Corps, 1941; Chief, Neuropsychiatric Section, Sta-
tion Hospital, Aberdeen Proving Ground, Maryland, 1941-1943; Director,
Consultation Service, ASFTC (Ordnance).
Joseph H. Pratt
Johns Hopkins, M.D., 1898; Physician in Chief, Boston Dispensary,
1927-1931; Physican in Chief, New England Medical Center; published
(with Col. George E. Bushnell) "The Physical Diagnosis of Diseases of the
Chest," 1925.
7
246 GROUP PSYCHOTHERAPY
Abraham A. Low
University of Vienna, M.D., 1919; Assistant Director, Psychiatric Institute,
University of Illinois; Founder and President of "Recovery," (Association
of former patients).
E. W. Lazelle
University of Colorado, M.D., 1902; Psychiatrist and Chief of Infirmary
Service, Veterans Administration, Northport, Long Island; published "A
Study of the Influence of Heterophile Antigen in Nervous and Mental Dis-
orders," Journal of Nervous and Mental Disease, July 1939.
Louis Wender
Long Island College Hospital, M.D., 1913; formerly Medical Director,
Hillside Hospital; Physician in Charge, Pinewood Sanatorium, Katonah,
New York.
Wladiwir Eliasberg
University of Heidelberg, M.D., 1913; Research Fellow, Speech Clinic
of the First Neurological Division, Goldwater Memorial Hospital, New York
City.
Nathan W. Ackerman
College of Physicians and Surgeons, Columbia University, MD,, 1933;
Psychiatrist, Menninger Clinic, Topeka, Kansas, 1937-1938; Chief Psychi-
atrist, Jewish Board of Guardians, New York City; published "Personality
in Arterial Hypertension," (Co-Author) Psychosomatic Medicine Mono-
graph, 1945.
Ernest Fantel
University of Vienna, M.D., 1935; Resident Physician, Beacon Hill Sani-
tarium, 1938-1941; On duty, Army of the United States, Medical Corps,
Neuropsychiatrist, 138th Evacuation Hospital, Camp Butner, North Caro-
lina.
Margaret Hagan
Field Director, American Red Cross, St. Elizabeths Hospital, Washing-
ton, D. C.
Edith Wright
Psychodramatist, St. Elizabeths Hospital, Washington, D. C,
8
AUTHORS' BIOGRAPHIES 247
Theodore R. Sarbin
Northwestern University, Ph.D.; Director, Psychodramatic Institute, Los
Angeles, California.
Gerhard Schauer
Formerly Assistant Physician, State Hospital for Mental Diseases, Howard,
Rhode Island; on duty, Army of the United States, Medical Corps,
Neuropsychiatrist, Lovell General Hospital, Fort Devens, Mass.
Lewis Barbato
Baylor University School of Medicine, M.D., 1930; formerly Instructor
in Psychiatry at the University of Texas School of Medicine; Superintend-
ent and Medical Director, San Antonio State Hospital, 1942; Chief, Neuro-
psychiatric Service at Fitzsimons General Hospital, Denver, Colorado.
Zerka Toeman
Willesden Technical College, London, England; Assistant Director, Psy-
chodramatic Institute, New York City; Assistant Managing Editor, Soci-
ometry, A Journal of Inter-Personal Relations, New York City; published
"Role Analysis and Audience Structure," Psychodrama Monograph No. 12,
1945.
John R. P. French
State University of Iowa, Ph.D.; formerly Psychological Research Con-
sultant, Harwood Manufacturing Corporation; now Research Director on
training program, Nejelski Co., Inc., New York City.
Florence B. Moreno
Teachers College, Columbia University, MA., 1937; Assistant Directory
Psychodramatic Institute, Beacon, N. Y.; published (with J. L. Moreno)
"Spontaneity Theory of Child Development," Psychodrama Monograph
No. 8, 1944.
/. Sutherland
On duty, British Army; Senior Psychiatrist, War Office Selection Boards,
Great Britain.
G. Fitzpatrick
On duty, British Army; Royal Army Medical Corps, Specialist in Psy-
chiatry, Great Britain.
248 GROUP PSYCHOTHERAPY
Paul Cornyetz
College of the City of New York, A.B., 1944; Research Assistant, Psy-
chodramatic Institute, New York City,
Ira M. Altskuler
University of Berne, M.D., 1917; Associate Psychiatrist, Wayne County
General Hospital and Infirmary, Eloise, Michigan; published "Rational
Music-Therapy of the Mentally 111," Music Teachers National Association
Book, Proceedings, 1939.
Leila A. McKay
Majored in biology and art; on duty, Army of the United States, Army
Air Forces Convalescent Hospital, San Antonio, Texas; initiated and carried
out Music Therapy Project at Convalescent Hospital, Fort Logan, Colorado.
Milton H. Ward
Formerly Instructor, Juillard School of Music, New York City.
Marian Chace
Experimental Class in Dance Rhythm, American Red Cross, St. Eliza-
beths Hospital, Washington, D. C.
Howard P. Rome
Medical Corps, Navy Department, Bureau of Medicine and Surgery.
Joseph L Meiers
University of Berlin, M.D., 1925; Neuropsychiatric Consultant of the
Mental Guidance Clinic, Riga, Latvia, 1933; published a number of papers
in "Revue Ose," Paris, 1935-1938; formerly Assistant Physician, Hillside
Hospital; Assistant Physician, Creedmoor State Hospital, Queens Village,
Long Island, N. Y.
10
ACKNOWLEDGMENTS
We are greatly indebted to the American Journal of Psychiatry for
the permission to release the papers read at the Round Table Conference on
Group Psychotherapy at the Centennial meeting of the American Psychiatric
Association, Philadelphia, May 16, 1944.
To the National Committee on Prisons and Prison Labor goes our
thanks for allowing the republication of the Round Table Conference on
Group Method held during the meeting of tjie American Psychiatric Asso-
ciation at Philadelphia, May 31st, 1932.
We are grateful to the British War Office, Public Relations Depart-
ment, for passing for publication the paper on approaches to group problems
in the British Army, and particularly to the United States Army Service
Forces, Office of the Surgeon General and to the Navy Department, Bureau
of Medicine and Surgery, for granting permission to present in this sym-
posium a number of individual reports.
11
249
FOREWORD
Two trends of thought, converging now and here, make most logical
an intensified interest in the application of psychotherapeutic methods to
and within the group one is the recognition of the truth long emphasized
by Meyer and White, that behavior is the result of the response of the
organism-as-a-whole to environmental influences among which people are
the most important; the other is the fact, demonstrated all too painfully
during the recent war, that the supply of psychiatrists is far below the de-
mand. Thus whether we view the needs of the situation theoretically,
interpreting psychiatry as dealing primarily with interpersonal relations, or
practically, recognizing the fact that we must either multiply the number
of psychiatrists or divide their applicability by treating several patients
simultaneously, we are inescapably forced to recognize the need and value
of group psychotherapy.
In the development of this form of treatment one thinks especially of
the pioneering work pf J. L. Moreno, the exponent of sociometry and of
psychodrama, whose originality, continuing guidance and enthusiastic sup-
port have been an outstanding influence through the years. It is no detrac-
tion to this pioneer to mention another an internist of keen psychiatric
insight, Dr. Joseph H. Pratt, pf Boston who is perhaps, next to Moreno,
the most important of the early .workers in group psychotherapy.
It was not, however, until the Round Table Conference at the Phila-
delphia meeting of the American Psychiatric Association in 1932, presided
over by the late Dr. William Alanson White, that a large and representative
group of psychiatrists met for a discussion on the topic; indeed, the phrase,
"group psychotherapy," had first been given currency (by Moreno) only
a year beforel It was characteristic of Dr. White's progressive spirit that
he should have discerned the .psychiatric possibilities of this approach and
given it support. It was completely in line with Dr. White's tradition that
one of his associates, Dr* Roscoe W. Hall of St. Elizabeths Hospital, should
have acted as chairman of the conference on Group Psychotherapy at Phila-
delphia in 1944,and that in the interval St. Elizabeths Hospital should
have become the first public mental hospital in the Ujiited States to intro-
duce Moreno's psychodrama.. It is therefore with peculiar pleasure that as
a representative of that Hospital I have accepted the invitation to write
this foreword.
This volume presents among other papers the account of the 1932
13
251
252 GROUP PSYCHOTHERAPY
and 1944 conferences, and thus gives the past and present. The possibilities
of psychodrama as a teaching method are just being tapped, and the treat-
ment potentialities of group psychotherapy are far from fully explored.
There is thus a future, yet to be presented; perhaps the next volume may
illuminate further the path that now lies ahead.
Washington, D. C.
October 17, 1945
WlNFRED OVERHOLSER, M.D.
Superintendent, St. Elizabeths Hospital.
14
THE APPLICATION OF THE GROUP METHOD TO
THE CLASSIFICATION OF PRISONERS
A Round Table Conference at the Annual Meeting,
American Psychiatric Association
Philadelphia, Pa., May 31, 1932.
Chairman
DR. WILLIAM A. WHITE
Those present were:
Dr, Franz Alexander, Cambridge, Mass.
Dr. Albert Anderson, Superintendent, State Hospital, Dix Hill, Raleigh, N. C.
Dr. Amos T. Baker, Director of Classification, Sing Sing Prison, Ossining,
New York.
Dr, Harry B. Ballou, Assistant Superintendent, State Training School and
Hospital, Mansfield Depot, Conn.
Dr. P. B. Battey, Superintendent, Westfield State Farms, Bedford Hills,
New York,
Dr. C, R, F. Beall, U. S. Penitentiary, Atlanta, Ga.
Dr. A. L. Beier, Chippewa Falls, Wise.
Dr. F. Lovell Blxby, Assistant Director, Division of Classification, Depart-
ment Institutions and Agencies, Trenton, N. J.
Dr. Malcolm A. Bliss, St. Louis, Mo.
Dr. V. C. Branham, Deputy Commissioner of Correction, Albany, N. Y.
Dr. Rene Breguet, Elmira, N. Y.
Dr. Charles M. Burdick, Medical Superintendent, Dannemora State Hos-
pital, Dannemora, N. Y.
Dr. Noble R. Chambers, Syracuse, N. Y.
Dr. Charles E. Clark, Trenton, N. J.
Dr. Edwin W. Cooke, Superintendent, Western State Hospital, Bolivar,
Tenn.
Dr. Lawrence M. Collins, Senior Assistant Physician, New Jersey State Hos-
pital, Greystone Park, Morris Plains, N. J.
Dr. 0. B. Darden, Assistant Resident Physician, Westbrook Sanitarium,
Richmond, Va.
Dr. Roderick B. Dexter, Superintendent, Foxboro State Hospital, Foxboro,
Mass.
Dr. Edgar A. Doll, Director, Department of Research, Training School,
Vineland, N. J.
IS
254 GROUP PSYCHOTHERAPY
Dr. W. K. Dyer, Psychiatrist, U, S. Industrial Reformatory, Chillicothe,
Ohio.
Dr. William J. Ellis, Commissioner, Department Institutions and Agencies,
Trenton, N. J.
Dr. W. S. Farmer, Superintendent, Central State Hospital, Nashville, Tenn.
Dr. A, W. Foertmeyer, Assistant Psychiatrist, Central Clinic, Fountain
Square, Cincinnati, Ohio.
Dr. Andrew C. Gillis, Baltimore, Md.
Dr. Daniel P. Griffin, Neurologist, Bridgeport Hospital, Bridgeport, Conn.
Dr. & Mrs. Thomas H. Haines, New York City.
Dr. Percy G. Hamlin, Clinical Director, Friends' Hospital, Frankford, Phil-
adelphia, Pa.
Dr. Edward L. Hanes, Rochester, N. Y.
Dr. Arthur H. Harrington, Providence, R. I.
Dr. S. W. Hartwell, Worcester, Mass.
Dr. R. D. Helmer, Director of Clinical Psychiatry, Utica State Hospital,
Utica, N. Y.
Dr. Morgan B. Hodskins, Superintendent, Monson State Hospital, Palmer,
Mass.
Dr. Quinter Holsopple, New Jersey State Prison, Trenton, N. J.
Dr. E. K. Holt, Medfield, Mass.
Miss Julia K. Jaffray, Chairman, Department of Public Welfare, General
Federation of Women's Clubs, New York City,
Miss Helen Jennings, New York State Training School for Girls, Hudson,
N.Y.
Mrs. Kate Burr Johnson, Superintendent, State Home for Girls, Trenton,
N.J.
Dr. E. R. Johnstone, Director, Training School, Vineland, N. J.
Dr. Benjamin Karpman, St. Elizabeths Hospital, Washington, D. C.
Dr. Jacob Katz, Chaplain, Sing Sing Prison, Ossining, N. Y.
Dr. Siegfried E. Katz, Senior Psychiatrist, Psychiatric Institute and Hos-
pital, New York City.
Dr. Frank W. Keating, Superintendent, Rosewood School for Feeble-Minded,
Owings Mills, Md.
Dr. Baldwin L. Keyes, Philadelphia, Pa.
Dr. Olga, Knopf, New York Hospital, New York City.
Dr. John A. Larson, Institute for Juvenile Research, Chicago, 111.
Dr. Sanmd Leopold, Philadelphia, Pa.
16
APPLICATION OF THE GROUP METHOD 255
Dr. A. Sandor Lorand, Adjunct in Psychiatry, Mount Sinai Hospital, New
York City.
Dr. Seymour DeWitt Ludlum, Gladwyne Colony, Gladwyne, Pa.
Dr. Thos, W. Maloney, Willard State Hospital, Geneva, N. Y.
Dr. Clinton P. McCord, Albany, N. Y.
Dr. P. B. Means, Assistant Physician, New Jersey State Hospital, Trenton,
N.J.
Dr. William E. Merriman, First Assistant Physician, Hudson River State
Hospital, Poughkeepsie, N, Y.
Dr. Matthew Molitch, Jamesburgh, N. J.
Dr. Joseph W. Moore, Division of Parole, State Executive Department,
Albany, N. Y.
JDr. Jacob L. Moreno, New York City.
Mrs. Fannie French Morse, Superintendent, New York State Training
School for Girls, Hudson, N. Y,
Dr. J. D. Mulder, Superintendent and Medical Director, Christian Psycho-
pathic Hospital, Byron Centre, Mich.
Dr. William L. Nelson, St. Louis, Mo.
Dr. Mary O'Malley, Director, Woman's Department, St. Elizabeths Hos-
pital, Washington, D, C.
Dr. Chaxles S. Parker, Kings Park, N. Y.
Dr. Wm. D. Partlow, Superintendent, The Alabama Insane Hospital, Tus-
caloosa, Ala.
Dr. Nathan Peyser, Brooklyn, N. Y.
Dr. I. L. Polozker, Director, Psychiatric Clinic, Recorder's Department,
Detroit, Mich.
Dr. Ellen C. Potter, Director of Medicine, New Jersey Department of In-
stitutions and Agencies, Trenton, N. J.
Dr. Arthur H. Ring, Superintendent, Ring Sanitarium and Hospital, Mass.
Dr. Frank W. Robertson, Stamford Hall Co., Inc., Stamford, Conn.
Dr. Perry C. Robertson, Medical Superintendent, Ionia State Hospital, Ionia,
Mich.
Dr. Manly B. Root, Director of Psychiatry, Department of Public Welfare,
Lyman School for Boys, Westborough, Mass.
Dr. Paul L. Schroeder, Institute for Juvenile Research, Chicago, HI.
Dr. William K. Skinner, Senior Assistant Physician, Warren State Hos-
pital, Warren, Pa.
17
256 GROUP PSYCHOTHERAPY
Dr. A. L. Skoog, Professor of Neurology, University of Kansas, School of
Medicine, Kansas City, Mo.
Dr. R. E. Lee Smith, Superintendent, Eastern State Hospital, Bearden,
Tenn.
Dr. Amy N. Staimard, Washington, D. C.
Dr. Calvert Stein, Palmer, Mass.
Dr. Geo. C. Stevens, Clinton, N. Y.
Mr. Richard Stockton, Elizabeth Fry Foundation, New York City.
Dr. Coronal Thomas, St. Louis, Mo.
Dr. Kenneth J. Tillotson, Medical Superintendent, McLean Hospital, Wav-
erley, Mass.
Dr. Frederick I. Wertham, Associate in Psychiatry, Johns Hopkins Hospital,
Baltimore, Md.
Mrs. Frederick Wertham.
Dr. William A. White, Superintendent, St. Elizabeths Hospital, Washing-
ton, D. C.
Mrs. William A. White.
Dr. E. Stagg Whitin, Chairman, Executive Council, National Committee
on prisons and Prison Labor, New York City.
Dr. B. 0. Wise, State Hospital, Howard, R. I.
Dr. A. R. T. Wylie, Superintendent, North Dakota Institution for Feeble-
Minded, Grafton, N. D.
PROPOSAL OF A PLAN OF GROUP PSYCHOTHERAPY
READ BY DR. WILLIAM A. WHITE
"The proposal for the Application of the Group Method to the Classifi-
cation of Prisoners has grown out of a luncheon conference arranged by
the National Committee on Prisons and Prison Labor through the courtesy
of the American Psychiatric Association at our meeting in Toronto, last
year, 1931, at which many of you were present. Dr. J. L. Moreno sug-
gested group psychotherapy of prisoners and as a result the. authorities
of the New York State Department of Correction permitted Dr. Moreno
in collaboration with Dr. E. Stagg Whitin,, Chairman of the Executive
Council of the National Committee on Prisons and Prison Labor, to carry
oa research at Sing Sing Prispn. Through their efforts, the plan has de-
veloped which is the topic v of our round table discussion."
18
APPLICATION OF THE GROUP METHOD 2S7
DR. WILLIAM A. WHITE,
Superintendent, St. Elizabeths Hospital,
Washington, D. C., presided:
After reading the Proposal stated:
The whole penological system is probably the last ditch "for man's
inhumanity to man" to yield. It is natural and hopeful that psychiatry
is directing its interests into the wide field of penal reform. There have
been a number of approaches, first that of the hospital and then the indi-
vidual analysis. Tonight it is the group psychiatric approach which we will
consider.
I remember visiting, a few years ago, a prison in the East with about
one thousand inmates.. It had no walls and only a few cells. The dormi-
tory system, similar to that in schools-, was in use. . On the first occasion
I found no men in .the solitary cells and on the second occasion only one.
The men were free to conduct themselves and the warden was clever
enough to handle the men so that they felt comfortable. They did not
run away nor did they conmut acts which would have made the running
of the prison impossible. The warden in his dealings with these men relied
largely upon his "intuition." This is a vague term, I know, and one much
over-used, but I cannot find any other word to express the way in which he
managed his men.
I speak sometimes of the inter-weaving of emotional streams among
people when they are in a group. These emotional streams bind people
who thus can be modified to and by the group. Ten or fifteen men within
a prison can and do sometimes bind themselves together and so gain con-
trol of the prison. The others have to do as they demand or their life is
threatened. This domineering group which takes the command of the
prison even out of the hands of the personnel may be segregated: that is
one method. The other, the one which concerns us today, is to study the
emotional cross patterns, to study whether groups within the prison cannot
be formed advantageously so that the men will live better and to the ad-
vantage of their fellows. ^This is the relating of the men to one another.
Moreno calls this approach<"Group Psychotherapy." As I looked over the
portion of Dr. Moreno's monograph which deals . with the structure . of
social groups,.! was interested in the chart? illustrating them. They look
like formulas in a book on chemistry. They reveal how strange and com-
plicated are human inter-relations and also how much we can profit from
the study of these structures in the successive stages of their development.
19
258 GROUP PSYCHOTHERAPY
Dr, Moreno, in a discussion with me just before this meeting, said
that the family is a rigid form of social grouping. We are not able to take
a parent or some of the children out and place them with some others, sub-
stitute other parents or children, and so forth. But if groups are formed
in a correctional institution, we are able to shift the persons from one
group to others for their advantage and for the advantage of the others.
These groups need not be rigid. They can be made flexible. Into the
forming of these groups all the factors uncovered about the individuals may
be synthesized. The knowledge which we have gained will go into the very
foundations of the groups.
On this unusual occasion of the large assembling here of outstanding
psychiatrists, criminologists, and experts in particular branches of penology,
it would be impossible for me to call upon all whom we should like to
hear speak. I shall try, however, to .make the discussion as widely repre-
sentative as time will permit, leaving it to you, Dr. Moreno, as the last
speaker, to clarify all questions which may arise.
First may I call upon you, Dr. Vernon C. Branham, who, as Deputy
Commissioner of Correction for New York State, have always given freely
of your interest and encouragement to every new and promising experi-
ment within the correctional field and in particular during the past year
have done all in your power to make possible the present research.
DR. V. C. BRANHAM:
In the consideration of this plan we are confronted from the very first
with the general prevalence of the old concept of an eye for an eye and a
tooth for a tooth in dealing with the criminal. Guilt was determined through
trials by ordeal and a regime of torture.
y In recent years only, has an approach been made to the prisoner him-
self. Lombroso emphasized the anatomical structure of the criminal. The
next stage was biological and psychological. The psychiatric approach came
later and showed that feeble-inindedness and insanity may make for
irresponsibility and criminal acts, and that distorted attitudes from early
childhood may be influential. At last came the sociological aspect which
emphasized that crime flourishes in certain districts untier certain environ-
ments.
The plan elaborated by Dr. Moreno, it seems to me, is the climax of
these Different efforts as it combines the individual with the biological, the
psychiatric with the sociological, urged by the aim to transform the prison
20
APPLICATION OF THE GROUP METHOD 259
into a cohesive, integrated, socialized community. Until the present time,
the two ends, the abstracted individual and the undisciplined mass, have
been studied, the one and the many. " But tfie social structures formed by
men between these two extremes has scarcely been touched. Yet man lives
neither as an individual for himself nor in a mass, but in small coteries in
which he attracts or repels and it is through his relation to these men that
his personality is developed. This is the starting point of Dr. Moreno's
plan. The question put forward is: Is it possible to form coteries of this
sort synthetically? To answer this question he analyzes the inter-relations
of men to one another and places them into groups as appears to their best
advantage. Out of this attempt an analysis of inter-relations and a sys-
tem of scoring grew which even in its beginnings contains a promising
direction for research and the germ of a workable method for social
organization.
This conference, I believe, should not attempt 'the discussion of these
very important technical studies, which may be left for a later time, but
should concentrate upon the larger aspect, the group treatment in correc-
tional institutions. A new principle of approach confronts us and I am
convinced that it will lead to a change in our outlook and our procedure.
DR. WHITE:
Throughout all society's dealings with the criminal, both in court and
elsewhere, the act has always been considered rather than the actor. At best
this is a very imperfect method. And even when the psychiatrist comes to
understand why the criminal did commit the particular act, this is also in-
sufficient. He again must consider the doer of this act and his inter-relations
with other people.
It will be interesting to hear now the opinion of one who deals con-
tinually with the classification of prisoners and who is able to tell, us if and
how the group method can be applied to a large prison population. I hope
Dr. Amos T. Baker who is the director of the Classification Clinic of Sing
Sing Prison will do that for us.
DR. AMOS T. BAKER:
My expectation was that Dr. Moreno would present a paper on the group
method first and I should then have, after him, an opportunity to con-
tribute my ideas. Thus I was prepared to ask certain questions. I feel I am in
the position of a patient whom I treated at Matteawan some years ago.
21
260 GROUP PSYCHOTHERAPY
He had received no answer which he considered satisfactory relative to his
situation, and so he spent a long time in making a great list of questions
which he intended to ask the physician. Confronted with the decision that
he would not be allowed to ask all of them, he said: "Well, then, I will
display them in evidence." Now I have asked a lot of questions about
Dr. Moreno's plan but have not yet been able to have them all answered.
So tonight I intend to take this opportunity to display them in evidence.
Much time has been given to classification but no plan has evolved
which has met the approval of the prisons. Certain prisoners have been
segregated, such as the psychotic and the feeble-minded, the tubercular, etc.
Two plans are actually in use in New York State: The diagnostic plan
which was adopted about 1926 by the legislature and an administrative
plan, devised by Dr. Branham.
I believe that the groupings of inmates is possible. But I would warn
against too hasty application to a prison and would suggest first a try-out
in small institutions. There are a number of practical rules which will be
gained through experience. The second step would be a try-out in a new
prison which is from its beginning better adapted to the demands of the
group method. In respect to the classification of the men into groups, I
would place greater emphasis upon the prognosis of each of the men. Symp-
tomatology, diagnosis and prognosis are the three principles upon which
group classification should be based.
Does Dr. Moreno consider the following difficulties: Will the leaders
be recognized as "leaders"? What are the objectives of classification?
Should not the younger group be kept apart in a special prison? Of every
one hundred arrested for a felony, only eight are convicted. What about
the ninety-two, guilty or not guilty, who remain in the community?
DR. WHITE:
It happens quite often that men who work in a certain direction for a
long while lose the freshness of thought and the daring to try out something
new. What we are interested in is taking the new in Dr. Moreno's ideas
and finding out what it is worth. We are not interested in where it comes
from but in getting something to use. Then we will find out what can
be done.
Some years ago Congress made an appropriation for a prison for Wash-
ington, D. C. Roosevelt picked a committee to decide upon recommenda-
tions and plans. Among those he chose was a banker, a very well-known
22
APPLICATION OF THE GROUP METHOD 261
philanthropist. Hearing of his appointment, the man immediately protested,
saying: "I cannot serve upon this committee. I know nothing about the
project. I never was in a prison in my life." The President responded:
"That's just why I want you," A prison was erected without walls and
with no cells. It still functions successfully. It is true the warden had
selective authority as to who went to his prison. But he had no scientific
means of knowing whom to allow and whom not. Probably he did it largely
by intuition.
This at least suggests the question whether our methods of managing
our prisons, are antiquated. Maybe a naive unsophisticated approach wiD
bring us closer to the heart of the matter. We have seen this happen so
often in the history of science and social reform. Now perhaps someone who
is in charge of guiding the development of children (whom we call delin-
quent because we have no better word) will be able to supply us with this
wider attitude towards the question. I will ask Mrs. Fannie French Morse
to speak, who is the Superintendent of the New York State Training School
for Girls, where Moreno's plan is being put into concrete application.
MRS. FANNIE FRENCH MORSE:
For the past thirty years I have been dealing with children in and out
of institutions, and out of this contact has been born in me a persistent
conviction that personality is the greatest single force to be considered in
handling them. Even in institutions the greatest factor is personality.
But how is it possible to put this influence of personality methodically to
work? I have tried to do this largely by intuition, but I believe that Dr.
Moreno's method makes the procedure accurate and controllable. There-
fore when he addressed my staff, we all realized that what he placed before
us in distinct logical terms was the thing we had always felt the need of
without being able to express it.
For years I have protested against the mechanical measuring of the
child. For a long time I arranged the cottages according to psychological
measurements. But I have never gone back to it. Something higher is
needed. The social fitness is the real criterion. More and more I am re-
\f
leasing the child, her spontaneous life. And I must say, it seems to work.
Why does one child choose another? It is not because they are the same
in intelligence or in some other factor, but because there is something in one
which appeals to the other. This "socializing" process is the great point
in developing human beings.
23
262 GROUP PSYCHOTHERAPY
DR. WHITE:
This is a hopeful note, and what is true for the adolescent cannot be
entirely untrue for the adult delinquent. I wonder if another woman of
distinction in the correctional field, Miss Julia K. Jaffray, Secretary of the
National Committee on Prisons and Prison Labor, and also a member of
the Board of Advisors, Federal Industrial Institution for Women, will tell
us the reaction of the people-at-large in our community towards this matter.
MISS JULIA K. JAFFRAY:
I bring greetings to this gathering from Mr. George Gordon Battle,
the President and the Board of Directors of the National Committee on
Prisons and Prison Labor, and also two messages:
First, the prisons are rapidly reaching the place where they can carry
on constructive work. The old slave system under which the prisons suf-
fered for almost one hundred years has been broken down through the pas-
sage of the Federal Law, known as the Hawes-Cooper Convict Labor Act.
This act becomes effective in January, 1934, and will bring about the
abolition of the prison contract system under which the labor of the prisoners
has been sold to private business interests. Graft and brutality are passing
out of the prisons and gradually men of high calibre with a broad educational
viewpoint are being recruited for the prison service. The time is ripe for
constructive work in the prisons.
My second message is that it is to men like yours that we must look for
leadership and guidance in the development of the new prison methods. We
ask you from the National Committee on Prisons and Prison Labor to give
to the prisons your very best and we have every reason to feel confident
that the method of grouping will be accepted and applied in the spirit in
which it is given.
DR. WHITE:
Moreno's method of grouping lays due emphasis upon one factor, the
personality of each individual man. To develop the group method suc-
cessfully we must not only know the inter-reaction of individuals with others
but must also know each individual. Psychoanalysis has revealed to us
many important facts in regard to the individual. What has it to con-
tribute in respect to method of grouping? Dr. Franz Alexander, Professor
of Psychoanalysis, University of Chicago, outstanding in the field of psy-
choanalysis and who has spent much time in the study of criminals, may
24
APPLICATION OF THE GROUP METHOD 263
be able to tell us what he considers the deeper determinants of criminality,
and in what respect he considers the group method applicable to the study
of crime.
DR. FRANZ ALEXANDER:
My knowledge of criminals has been very limited. I know very few
because I have been burdened with their psychoanalysis. But I may say
that I know those few very well. With Dr. William Healy working for the
Baker Foundation, we have handled eight cases which would fill three
volumes. Our results have led us to make a distinction between the psy-
chological criminal and the sociological criminal. And the more I deal
with criminals the more I am convinced that the therapeutic treatment of
them cannot be solved by the sociological or the psychological alone.
This is demonstrated by the fact that certain areas of the world's
large cities contain twenty times the number of criminals produced by other
areas. Only a certain percentage of the persons living in the criminal areas
becomes criminal, and that means there is a certain class more susceptible
to criminal impulses than others.
Tendencies cannot be traced to economic reasons entirely, either, be-
cause the majority of us faced with starvation would perish rather than
commit crime.
Those who break the laws are, however, found to be those who come
from the strata which is least interested in upholding the law. But still only
a certain percentage even here become criminals. It works on a basis of
selection. Which are those? It is a problem for psychiatry. Before we
go on readjusting criminals we have to classify the etiological factors and
the social factors which led to the committing of crime. Those earlier
family influences, etc., were the same for many. But only a few became
criminals. What is the explanation? It is of first importance that the
psychiatrist should divide criminals into two classes, those who are forced
by the economic instinct of self-preservation and those who enter lives of
crime because of prenatal or early family influences which cause psycho-
logical maladjustment.
Aggression against the family leads into aggression against society. The
child victim of a brutal father or bullying brothers sometimes turns aggressor
against them and this results in the aggression against society as a whole
when the individual reaches criminal age.
Many criminals have confessed that after the commission of a crime
25
264 GROUP PSYCHOTHERAPY
they felt a relief from anxiety and fear disclosing that in some cases crim-
inality gives opportunity for getting rid of the effects of emotional malad-
justment.
Another who cannot outgrow his criminal tendencies may have a neuro-
sis. Emotional tension is sometimes relieved by holding up a store. Crim-
inality in this way displaces a neurosis. I do not know if Dr. Moreno's
group plan can help in the psychological cases which are due to early
experience. But it may be very helpful for the sociological cases. With
the psychological cases, changes in the environment did not aid, we found.
Criminal behavior is the same as a maladjustment of neurosis. Readjust-
ment which is a psychological problem can only take place with psychological
individual treatment. And the jail is not the place in which to make a
psychological approach. Those who need it must be "sentenced" to hospital
care not to prison.
DR. WHITE:
I wonder if it is possible to make a distinction between the social and
the psychological criminal as Dr. Alexander says. It seems to me that this
distinction is rather one of degree. These two factors are always so inter-
woven that we have to recognize the fact that there are quantitative but
no qualitative differences between them. If this is true, then the contention
that there is need for a different approach to these two types of cases can
be doubted. The criminal got his values as a child from his environment
and the psyche itself is part of that environment. The two are so inter-
jected into each other that it is not possible to make a dear distinction.
Even if it should be maintained that the individual approach is the best,
it still remains a hopeless problem to psychoanalyze everybody. Torture
also as a means of punishment we know activates aggressiveness in all
prisoners. Can we not rely upon the bonds among men as a means of
reforming them?
We have heard from the psychiatrist, the educator, and the psycho-
analyst. Now we would welcome the opportunity to hear what the admin-
istrator and expert in prison organization will add to our discussion about
the group plan. I should like to introduce the Commissioner of Institutions
and Agencies of the State of New Jersey, Dr. William J. Ellis.
COMMISSIONER WILLIAM J. ELLIS:
There is a distinction, that from the same environment some commit
crime and others do not. But I would suggest that there is a third group:
Those who commit crime and get away with it.
26
APPLICATION OF THE GROUP METHOD 265
The difficulty as I see it of applying Dr. Moreno's plan to the prison of
today lies in two big facts: One is the architecture and the total make-up
of our prisons; the other is the personnel The cramped quarters and the
limited qualification of our personal are the mechanical hindrances for a
try-out.
I would suggest the application of the group method to the juvenile
training schools and if the results there suggest it, to build more suitable
prisons and to educate better fitted personnel to carry out the plan to its
fullest possible success. I see a slow and gradual development instead of a
quick and hasty change of procedure,
I am sure that the other representatives from New Jersey who have
studied the plan will be able to throw light upon other phases of the group
method.
DR. WHITE:
It is time, I think ; that we direct our attention for awhile to the
technical aspects of the Group Method as such. I am going to ask someone
who has taken the time to study the method in its particulars, Dr. F. Lovell
Bixby, Director of the Division of Classification and Education in the De-
partment of Institutions and Agencies of New Jersey, to treat this subject.
DR. F. LOVELL BIXBY:
I have had the opportunity to discuss personally with Dr. Moreno his
principles and methods of grouping after reading again and again his
written material. I believe that it is an important contribution, very stimu-
lating to thought indeed. Therefore, I am sorry that so much time has been
lost by general discussion instead of arguing about the method of grouping
itself.
One of the principal thoughts in Dr. Moreno's plan is to recognize
that persons affect one another in a direction advantageous or disadvan-
tageouTfortKem'and that we should not stop in recognizing this fact but
attempt to make use of this principle through a well calculated strategy 'of
procedure. It cannot be doubted that this thought is fundamental. I re :
member how well my own boy gets along with his friend next door. But
when sometimes his cousin comes, there are quarreling, arguments, and dis-
cordance generally. Obviously the intrusion of the third boy into the pic-
ture has changed the relationship between my boy and his friend.
Dr. Moreno attempts to study systematically these interactions and
27
266 GROUP PSYCHOTHERAPY
their products, aiming to find criteria and to suggest the placing of a man
in the same group with certain other men or warn against it. Here is the
place where I cannot entirely follow Dr. Moreno. I do not believe that
psychology or psychiatry is at a point where it can be foretold what the
relationships so arranged will produce. We cannot even foretell what the
relationships of two individuals will result in. How could we foretell what
the outcome of the relations between eight or ten persons would be whom
we have placed together into the same group? However, Dr. Moreno's
proposition may be a beginning and as the principle is sound, I can see
that progress in this direction can be made.
Still less satisfactory seems to me the division into the conserving and
spontaneous reaction types. We cannot divide the prisoners any more this
way than we can into the introvert and the extrovert. They are in them-
selves a group product anyway. I know I am more spontaneous with some
people than with others. As to the scoring system, Dr. Moreno has con-
structed to estimate the degree of value one man may have for another,
our emphasis should lie rather than on mere summation of the beneficial or
disparaging factors, on their integration.
DR. WHITE:
Let us hear more about group technique. I will ask the Director of
the Department of Research at the Training School at Vmeland, New Jersey,
Dr. Edgar A. Doll.
DR. EDGAR A. DOLL:
This afternoon I also had the opportunity to find out more about Dr.
Moreno's idea by having a talk with him.
It seems to me that the group method is extremely important but not
yet comprehensive enough. I can see its mental hygiene value as long as
the man is in prison. But the improved status of the man within the
prison would not determine the correctional value of the plan. The man
has failed on the outside. If we make it easier for him on the inside and
less complex do we not send him back into the community untrained and un-
prepared for the more complex situations?
The technique of group classification ought to lay more emphasis, as
Dr. Baker said, on the symptomatology and prognosis of each man. We
ought to develop treatment according to causation, physical, mental, per-
sonality, etc.
28
APPLICATION OF THE GROUP METHOD 267
In prisons as they are today it is hardly possible to use this method.
Possibly institutions for the juvenile will find it valuable.
DR. WHITE:
Let us hear now from Dr. Quinter Holsopple of the Department of
Institutions and Agencies in New Jersey.
DR. QUINTER HOLSOPPLE:
Listening to the various speakers tonight I am reminded of the way
one feels sometimes during the giving of the Form Board Test, when the
subject gets stuck and persistently attempts over and over again to put
the wrong piece into the space. You cannot stand it any longer and you
want to say: "Oh take them all out and start over again." But since we
are giving the test, we can not say that, we have to go right on watching.
Now it seems to me that we have about come to the point I speak of here
tonight.
Let us go back to the start, to the fundamental issue, to what Dr.
Moreno is driving at. He has pointed out that the psychological products
which emerge from the group are of profound importances. Since they
come from the group Dr. Alexander's distinction between the sociological
and psychological criminals is untenable. Certainly every act has psycho-
logical and sociological determinants. We ought to study the complete
products of inter-relations and base upon them a better balanced system of
social organization than we have today. I agree with Dr. Moreno that
it is in this direction that we must work if we want to develop the correc-
tional institution beyond its present state.
Also the value of the Spontaneity Test cannot be determined through a
discussion but through an actual try-out. I intend myself to make use of
it as one in the battery of tests we are trying out at present and am looking
forward to interesting results.
DR. WHITE:
I should like to ask for several more opinions before I come to Dr.
Moreno,
Let us hear now from a representative from Illinois, Dr. Paul L.
Schroeder of the Institute for Juvenile Research.
DR. PAUL L. SCHROEDER:
I -was impressed with the plan as a technique. To put it into success-
ful practice a different type of personnel has to be trained, however. At
29
268 GROUP PSYCHOTHERAPY
present the officers are too much concerned with the offenses the inmates
have committed and too little with the men themselves. The success would
largely depend upon the personnel employed.
Contrary to common belief, delinquents and criminals tend to develop
group feeling of a cohesive nature. In view of this approach their rehabili-
tation can be effectively brought about through the group approach. The
matter of cohesion is not clearly understood, however, it appears that it stems
from a feeling of similarity in their relationship with society in general
and persons in authority individually. Use can be made of this common
feeling not only during the period of institutionalization but possibly also in
the early period of their return to their local community.
It was with this in mind that the Institute of Juvenile Research or-
ganized and established a local neighborhood program for the study and
treatment of juvenile delinquents under the title of the Chicago Area Project,
This program has been in effect since 1931 and has been extended to a
number of delinquent communities in Chicago. The progress made fully
justifies the philosophy that the control of delinquency and crime in the
local community must come through an awareness of the people of that
community of its need and be effected through their own efforts. *
DR. WHITE:
Let us hear from another woman who has distinguished herself through
her work as Commissioner of Welfare in Pennsylvania and who is now
Director of Medicine for the Department of Institutions and Agencies in
New Jersey, Dr. Ellen C. Potter.
DR. ELLEN C. POTTER:
Personality as a factor in treatment is certainly extremely important.
It seems to me also that the question is: how would it be possible to
secure personnel to put this plan into operation? I do not believe we are
staffed now to do it properly.
DR. WHITE:
We should like to hear from the State of Massachusetts: Dr. S. W.
Hartwell, formerly with the Judge Baker Foundation.
DR. S. W. HARTWELL:
If any of us change, it is because of other people. We change through
the personality equation. It seems to me that this plan is the only plan that
*The text between dashes ( ) has been added by Dr. Schroeder, October 1945.
30
APPLICATION OF THE GROUP METHOD 269
can ever help to change the criminal. It can make him more stable in his
emotional life and mentally more healthy. And we cannot do this without
relating him to other persons.
DR. WHITE:
Perhaps Dr. Benjamin Karpman who works with the criminally in-
sane at St. Elizabeth's Hospital in Washington, D. C, will say a few words.
DR. BENJAMIN KARPMAN:
How can a physician have come to the group notion? I do not under-
stand. The group method arises as a compromise as we cannot afford the
other, the individual method. The only way to secure results is by a com-
plete individual study and if we have that then we will not need the group
method. Also it is known that prisoners get along very well with other
prisoners anyway.
It seems to me that group psychotherapy can only be done in cases
where there is a certain community of emotional interests among those who
compose the group, as well as in their attitude toward the therapist or the
leader of the group. No such thing is possible so far as I know in work with
criminals. For one thing the criminal looks on everybody outside of the
prison inmates as people entirely foreign, even inimical to his interests. As
the saying among them is: "We are on the inside looking out; you are on
the outside looking in, and we can never understand each other." Though
among themselves criminals are reputed to be very loquacious and friend-
ly, this is not really the case. There is a great deal of bragging among
them, as one telling the other what wonderful crimes he has committed, how
he cheated the law more than the others, and what a master-mind he is.
Of his real problems he rarely talks either to prisoners or outsiders, and
would not talk as long as there is the wall between him and the outside
world. Therefore, I cannot see in the present state of affairs how group
therapy with criminals could be at all possible. Even individual therapy is
fraught with many difficulties, but with all the difficulties, it is the only one
which is at present available. The difficulties consist in the Chinese wall
of hostility that exists between prisoners and the outside world. For hours
and days and weeks the man would just bluff and bluff. One has to know
how to penetrate the thick fog which separates him from the rest of the
world and then he may open up. Instead of expecting transference to de-
velop in the usual way as we get among neurotics, it is our turn to give
31
270 GROUP PSYCHOTHERAPY
him transference. We have to give him undoubted evidences of genuine
affection in order to desolve the tremendous amount of thick hostility that
has accumulated in him.
Not So far as I can see and for some time to come yet, criminals
will have to be treated on strictly individual basis and with greater sacri-
fice than is required of us with any other type of neurotic,**
DR. WHITE:
Now that we have heard the most varied attitudes towards the topic
of our discussion, I beg Dr. E. Stagg Whitin, Chairman of the Executive
Council of the National Committee on Prisons and Prison Labor, to express
his point of view as one who has worked in the prison field for over twenty
years.
DR. E. STAGG WHITIN:
On behalf of the National Committee on Prisons and Prison Labor
and in confirmation of the words of appreciation to the American Psychiatric
Association already voiced by Miss Jaffray, my colleague, I desire to em-
phasize the importance of this gathering. While warring against adminis-
trative and economic abuses in our prisons, the committee has ever been
mindful of the individual prisoner, and his rehabilitation. We have been
trained by the medical and psychiatric leaders on our boards to look to
these groups for the answer of the personal problem of the prisoner.
When Thomas Mott Osborne was president of our organization, a com-
mittee was appointed under the chairmanship of Helen Hartley Jenkins
directed by our old friend Dr. Walter B, James, President of the New York
Academy of Medicine and our beloved Thomas Salmon. An appeal to the
Rockefellers brought the money and with Dr. White's blessings we financed
Dr. Bernard Check's experiment at Sing Sing. The result was the com-
mitment of New York State to building and equipping the classification in-
stitution at Sing Sing "out of which the developments described by Dr.
Branham and Dr. Baker have come. I always held in mind the advice
of Walter James: "Whitin, beware of the factions in the psychiatric field." I
want to see all groups represented on the staff at Sing Sing and force them
to work together let dog eat dog then we will get somewhere. Fifteen
years have passed, a substantial fund has been spent by research founda-
tions and state governments. Last year we made a study to ascertain the
**Tte text between dashes ( ) has been added by Dr, Karpman, October 1945,
32
APPLICATION OF THE GROUP METHOD 271
value of the findings in the several states. Conscientious men had examined
a great many prisoners and the records were on file. A method of classifica-
tion was in vogue but there was need for a thorough analysis before this
material could be made a basis for guiding the broad lines of even the
building program which was under way in several states. It was obvious
also that it was the exceptional administrator who could envision the
opportunity of using the information for administrative purposes, and even
this was retarded by technical terminology and a lack of technique in its
application to therapy. Commissioner Ellis in New Jersey, The Lewisohn
Commission in New York based their programs upon the work initiated
by Colonel Sears, and a start was made toward rationalizing our building
program.
At Toronto at the round table which was the forerunner of this meeting
tonight, I asked you psychiatrists to tell us how to actually make use of
this psychiatric work in the administration of the penal institutions. Your
kind reception of my request led to a general discussion whch was followed
by the volunteering of Dr, Jacob L. Moreno to give us a concrete answer.
Moreno was a stranger to me, and I was surprised as well as pleased by his
audacity in daring to come forward with an answer. His answer was put
in writing. Experiments have been made at Sing Sing, in a public school in
Brooklyn, The Riverdale Country Day School and at the New York State
Training School for Girls under Moreno's direction. The basic philosophy
has been discussed tonight, and this with a preliminary statement of
technique together with the comments of those who have watched the de-
velopment are contained in the monograph which is in your hands this
evening. I personally do not pretend to pose as an authority on this con-
tribution. It happens to be in accord with educational philosophy I learned
under Dewey, Thorndike, and McMurray at Columbia. It harmonizes
with my work in settlement groups in the experimental school I ran under
Teachers College. It clicks with the intensive work I did with Osborne in
self-government, but you are the authorities. We, of the National Com-
mittee on Prisons and Prison Labor, believe that after fifteen years, and
the spending of a substantial sum of public money there should be an
answer which can be made clear to the prison administrators. Moreno has
made an honest attempt to give an answer. If this is not an answer, who has
got one? Hundreds of thousands of men are being poured back into society
from our institutions worse than when they went in. These disordered minds
have developed a crime situation which threatens our civilization. Legis-
33
272 GROUP PSYCHOTHERAPY
latures are curtailing their expenditures for government activity so as to
feed the starving. The National Committee on Prisons and Prison Labor
wants to plead with the legislatures to continue their appropriations for
psychiatric service, and enlarge that service. Is the expense of it at this
time when people are starving justified by the results? You will pardon me
if I issue this challenge, but I remember how little is the profit from private
practice at this time, and how desirable it is, if only from a selfish pecuniary
standpoint that you help maintain and develop the opportunities for honest
service in the institutions which operate under our governmental budgets.
Dr. White, whose magnificent analysis of Moreno's proposal has
kindled in me a great hope, has' consented to draw together a group which
will face this problem four-square, and I give way now to Dr. Moreno whom
I trust will lift us from the sordid realities to a more spiritual approach to
the opportunities which are afforded by his proposal.
DR. WHITE:
Now I will beg Dr. Moreno who is the originator of this group plan
to talk on the subject. I am confident he will be able to answer all the
questions and to wind up the discussion to the satisfaction of all.
DR. JACOB L. MORENO:
It is a heavy load which Dr. White has put on my shoulders. I do not
know how I can answer in a few moments what I have attempted to present
in a hundred-page monograph. Unfortunately also, we are here not in
an institution or in a community, I cannot invite you to walk around with
me and see how the plan works, I am enclosed with you here within these
four walls. It seems I have only words at my disposal. But there is a way
out if you will not take any offense. If you will allow me to use you your-
self, our own grouping, here and now, as material for diagnosis. If you will
allow me to let my imagination run and describe you as if you were char-
acters in a play, then I may have to use fewer words and we will reach a
better understanding. This method of direct demonstration has been often
used by Socrates. He had to drink the hemlock for it; I hope you do not
mix a potion for me after you have heard what I have to say.
Let us then, Ladies and Gentlemen, look over our group here and see
what is characteristic about it at first glance. This situation as a per-
formance was not prearranged. It is like a spontaneity test. Most of the
participants made up their minds only a few hours ago to attend this
34
APPLICATION OF THE GROUP METHOD 273
meeting and as it was to be a round table discussion, everybody was welcome
to act in it. Nobody knew ahead how he would act in it and only a
few knew before time that they might act in it. Even if we assume that
the speeches of our participants could have been predicted were their indi-
vidual equation fully known, the clashes of the attitude of one speaker
with the attitude of other speakers and the products of these clashes are
psychologically a novelty. This was, then, an "impromptu" situation with
a common theme, the group method, and with a chosen leader, Dr. White.
But none, even Dr. White, knew what would happen and all were
curious to watch how he would develop the dialogue back and forth. As
no individual actor in this situation had prepared himself exactly how to
meet it, many of the attitudes taken in speeches were produced on the
spur of the moment and we could observe that they were more or less
modified by the attitudes of the other speakers of the group. We saw the
influence of the actual present constellation upon each of the persons here,
irrespective of what his performance concerning the same theme would have
been if he had been alone in his living room writing about it or discussing
it in a different group with a different set of persons.
We have, for instance, a number of New Jersey men here. Definite
and established minds, as Dr. Bixby and Dr. Doll, would perhaps have stead-
fastly repeated the same performance in every group, always inclined to
take the opposite stand whereas the more flexible Dr. Holsopple might
take the side of the underdog under all circumstances. But however inde-
pendently each of them has been seen to act, there is an interrelation between
their attitudes, even when they contrast, which melts them into an intellec-
tual gang.
There are, too, a number of distinguished ladies in the group. Did it
not seem also to you that they had a reaction in common, rather in favor
of the group plan? Is it sympathy for an innovator who has to overcome
repulsion and resistance? Or is it due to their sitting around the same
table, influencing each other?
As "leader" of this group and moderator of the discussion had been
chosen Dr. William A. White from Washington. The fact that this is by
far the best attended round table of the annual convention of the American
Psychiatric Association demonstrates that a great number chose spontane-
ously to be in the group in which he "leads." Certainly for many of them
the theme under discussion has been of secondary consideration. Dr. White
has the prestige of a good abbot, he has "fatherly" qualities. He has a
35
274 GROUP PSYCHOTHERAPY
gift of balancing one against the other. Then, too, it may be said he is
superior in strategic intelligence and experience in debating to all, perhaps,
who have contributed to the discussion. Does he not fit into the qualifica-
tion we demanded from a leader? If we affirm this, then we come to
consider what effect his behavior during the discussion had upon the various
speakers who participated in it and upon the performances as a totality.
First of all he enforced a level of dignity and moderation of attitude the
absence of which would have led to a total failure of the discussion which
centered about a most difficult topic. He prevented ridicule which so often
finishes attempts of pioneering. The strength of Dr. White's presence has
been felt by aH.
Let us imagine how different the performance would have been if
instead of Dr. White another man, for instance, Dr. Karpman, had been
chosen as moderator. I believe that almost every one of the twenty-five
speeches would have been different in content. Perhaps many who did
speak would not have spoken at all, and others who have been silent this
time would have rebelled. It might have come to dashes and to a sudden
breaking up of the discussion. A different picture might have resulted if
Dr. E. Stagg Whitin had been chosen as moderator. The discussion would
have become a cross section of correctional endeavor in the United States and
have run off into prison industries, his favorite topic. Thus the prison men
of the group would have come into the limelight and the psychiatrists would
have been pushed aside. Still less wise would have been the choice of myself
as moderator. The number of participants would have been small and the
round table would have become a dramatic clash between group psycho-
therapy and psychoanalysis.
These imaginary effects would not be due, as we have found in many
studies of group structure, to the make-up of personalities in question alone,
but largely to the position they occupy within the structure of the group
present. This "position" is not determined by their wishes and abilities
only but it is determined by the sympathies and antipathies of all other
members of the group. Of some of these influences a member of a group
might be aware and of others he might be fully unaware. This is true even
of an improvised group formation as ours is, largely because many of the
participants have affected each other either through personal acquaintance
or by indirection. If we should try to state the attitudes of sympathy,
antipathy, indifference--and of the deeper emotions underlying them each
has towards each other person of this group, we would find a very curious
36
APPLICATION OF THE GROUP METHOD 275
crisscross, revealing by close investigation the position and the influence of
each person, It may show Dr. White as receiving sympathy from the largest
number and thus we see how fortunate it was that Dr. White was won
to function as moderator. The ladies who were so excellently represented
by Mrs. Morse, Miss Jaffray, Mrs. White, Miss Jennings, Dr. Potter, Mrs.
Johnson, might have received little or no opportunity to speak if we had a
moderator less gallant. Again it may reveal others as having the position
of the isolated or of solitaires. The study would also show doubtless many
mutual-friends-structures, pairs who have a special intimate relationship
due to common scientific interests as the two psychoanalysts, Dr. Alexander
and Dr. Lorand. It may disclose a surprising number of structures includ-
ing three or more persons set off from the larger assembly, such as, for
instance, the Public Health group.
Last, not least, we find besides most desired individuals, solitaires,
mutual pairs, dissatisfied aggressives, gangs etc., still another condition
which illustrates the psychology of grouping. There is an individual here
who is in a similar situation to that of Dr. White, only in the opposite sense.
He is also a center, but he may be the center of resentments and repulsions,
not of attractions. He is undesired like a solitaire, but he has a certain
distinction: he is the prototype of the unwanted individual who attempts to
impose something upon a group that is by its very nature critical and sus-
picious towards him as towards anyone who assumes authority before the
reason for it is fully demonstrated. This person is, as you may have already
guessed, myself.
Of course, to make a special research of this status nascendi group,
arrangements should be made so that its participants could live together for
a period. New factors will then come into effect and consequently new inter-
relation will be established. In time, due to living together, face to face,
the picture of the group structure might change considerably from the
present. Of influence may become the fact that some men have studied at
the same university or have practiced in the same hospital or have founded
coteries together due to common scientific, political, social or religious
interests. However, perhaps, the most persuasive demonstration of the
group method would be if all the members of this group would volunteer
to stand a sentence of one year in one of our prisons. Let us form a
"Therapeutic Society." Many maladies have been studied with success by
physicians through experimentation upon themselves. Why not apply this
same principle to the problem of group therapeutic organization?
37
276 GROUP PSYCHOTHERAPY
A teacher greater than Socrates has given us an indication how this
can be accomplished, the originator of the Christian monastery, Jesus of
Nazareth. Indeed, the group of men and women around him is the matrix
of the later monastery and far more astounding than the miracles is the
manner in which he penetrated situations and prompted conversions and
cures in the midst of social actuality. Intuitively recognizing the position
each person had in a group, he played one against the other to produce
effect where it was least expected. He treated Judas in arguing with Peter,
Martha through Mary, the Pharisees through Magdalen. Indeed, the
monastery was in its origin an attempt to "improve" society, a sample of a
new social order, more characteristic for Christian pioneering than the
church. It was some sort of group-healing, one man correcting and inspir-
ing the other, a correctional institution.
The family structure is rigid, parents are bound to each other, children
to them and to one another by natural laws. Parents and children cannot be
taken out from one family and transferred to another. But the monastery
is free from natural bonds. It is exactly here where the Christian monas-
tery in its attempt to place together individuals of the most varied back-
grounds to form "synthetic" families was driven to ingenious methods of
grouping. Two distinct movements can be distinguished in the develop-
ment of the monastery. The one type can be called the individualistic type
of monastery, flourishing particularly in Egypt and Syria during the first
centuries of our calendar. It was an attempt at cure, through solitary means
only, barring as a vehicle of development the value of attractions and
repulsions which happen to the individual in a group association. It rep-
resents an attempt in the spontaneous, activistic direction, and it is a strictly
individual-centered procedure. This kind of monastery gave way gradually
to the '"coenobitic," group-centered type of monastery. The solitaire way
to sainthood, helpful to a few outstanding individuals only, proved a failure
to the large number of monks who develop better in an organization which
provides, besides the training in solitude, the training through friction with
other individuals which was most excellently demonstrated in the rule of St.
Benedict. The head of the monastery was the abbot, meaning father. To
make as intimate a contact between the abbot and his monks as exists
between father and children of a family, he suggested the monastery to be
small in number and asked that it be subdivided in small units of about
twenty members, each of them to be headed by an abbot substitute. We
see here the notions of the leader and the small contact group evolving.
APPLICATION OF THE GROUP METHOD 277
But when he transferred an unbearable monk from one monastery to another
the seed of sociometric assignment was already planted. The shifting of
men from one group to another was possible within the monastic organiza-
tion due to its spiritual make-up and this is an advantage it had compared
with the family to which the members are permanently attached by an order
of nature.
But is it possible to go beyond these symbols and metaphors and to
develop an exact science of group organization, a "sociometry"? Our experi-
ments have shown conclusively that this can be accomplished, if first of all,
methods are discovered which make a quantitative and qualitative analysis
of groups possible. These methods are being studied in the New York
State Training School for Girls at Hudson. They are, although still in
the process of development, of reliable accuracy. Once the quantitative
and qualitative composition of the groups which a community consists of
is known, the foundations for a scientific group psychotherapy are laid.
Then the question arises: how is it possible to reshape and correct groups
whose inner organization is found to be deficient?
Through techniques of reorganization, assignment, retraining and other
methods of group manipulation which assist each member of the community
in finding for himself the most desirable place, the abodes of the unfor-
tunates, correctional institutions and training schools, may bring about for
our time what the monastery accomplished for its age, a renaissance of
society.
39
GROUP PSYCHOTHERAPY
A Round Table Conference at the One Hundredth Annual Meeting of
the American Psychiatric Association, Philadelphia, Pa., May 16, 1944
CHAIRMAN, DR. ROSCOE W. HALL
Discussants: Drs. Nathan W. Ackerman, Lauretta Bender, Comdr. Francis J.
Braceland (MC) USNR, IX Col R. Robert Cohen M.C. (by invitation),
Drs. Maxwell Gitelson, Samuel B. Hadden, Lt. Comdr. Herbert Harris (MC)
USNR (by invitation), Frances Herriott (by invitation), Drs. Abraham A.
Low, Jacob L, Moreno, Maj. Samuel Paster, M.C., Stephen Sherman, PA. Surg.,
U.SP.H.S. (by invitation), Bruno Solby, Surg. (R) U.SJP.ILS., Drs. Alfred P.
Solomon and Louis Wender
ROSCOE W. HALL, M.D.
Saint Elizabeths Hospital, Washington, D. C.
INTRODUCTORY REMARKS
A number of years ago in a preface to some book, Dr. Adolf Meyer
wrote, "Hospitals are attempts at mass treatment, gradually working their
way back to the individual patient." In a sense, group psychotherapy has
been used for generations in mental hospitals. In his book "Administrative
Psychiatry", published in 1936, Dr. William A. Bryan has a lengthy chapter
on the subject. In Psychosomatic Medicine, April 1943, Dr. Giles W.
Thomas, unfortunately since dead, published a very worthwhile review of
the literature on the subject. His review was comprehensive and at least
attempted to be critical. Unfortunately, in several instances he was depend-
ent entirely on the publications of the authors and it was another instance
of the importance of "who said what?" as well as "what was said?" I do
not mean to stress the importance of "authority" because "authority's"
foot can slip on occasion, but to call attention to the fact that at times
printed words may give no indication of the worth, or lack of it, of their
content.
On one occasion in commenting on Count Alfred Korzybski's work
Dr. William A. White said, "I do not know what it is all about but I
believe that he has something by the tail" I feel somewhat the same way
about group psychotherapy. The psychoses and psychoneuroses present
psychotherapeutic problems along two main lines adaptation and insight;
and while the latter is highly desirable, the former, that is, adaptation, is
more essential. We have all seen patients make surprisingly good improve-
41
280 GROUP PSYCHOTHERAPY
ment or recovery with no evident insight, and, conversely, there is no more
pathetic sight than that of a patient who can glibly describe his conflicts,
complexes and mate-up, perhaps in psychoanalytic terms, but who is un-
willing to make any better adaptation than occupying a ward or park bench.
The goal of psychotherapy is a combination of these two lines,, adaptation
ajid insight It is the release of energy that is bound by internal conflict
and interest and the intelligent direction of all available affective energy
to channels that lead to more healthy social adaptation. The process of
psychotherapy might be described as an affect-mobilization (transference).
Presumably group psychotherapy lays more stress on insight but it seems
to me that no less stress should be laid on adaptation, and group work can
be made peculiarly useful to this end. It is in a larval and heterogeneous
state at present but it seems to have abundant vitality and to be arousing
increasing interest. When the organization of this so-called round table was
wished on me, even at the risk of diversity and bulkiness it seemed desirable
to have various aspects presented and hence we have speakers on preven-
tion, on children, on psychodrama and on group psychotherapy 35 most of
us recognize it.
A pertinent question deals with the special characteristics, if any, of
the group therapist. There have been a number of articles on the subject
of group therapy in the British medical journals and apparently the interest
in it has been based mainly on the need for treatment of larger numbers
of individuals and the paucity of physicians. Dr. Frank Fremont-Smith
through the Macy Foundation has done a very useful job in distributing
copies of these British papers to our medical service personnel. In this
country the same need has existed to some extent but also there have been
a number of physicians who have interested themselves in group work
because they do better with groups than with individuals and are of the
"hire a hall" type. Psychiatrically they might be described as hypomanic
extroverts and "proceed with caution" means little to them. For the more
unvocal physicians I am wondering about the possibility of the use of a
recording on the various subjects that almost uniformly come up in group
discussions. Despite our emphasis on "rugged individualism", it seems to
me that group psychotherapy should find a particularly fertile soil in the
United States with its penchant for conformity, experience meetings and
Chautauquas.
Captain A. A. Marsteller of the Naval Medical Corps, recently returned
from the South Pacific, told me that he came in contact with no organized
42
GROUP PSYCHOTHERAPY 281
group psychotherapy but that he had seen a number of instances where at
morning sick call the symptoms of one individual were discussed before
the other complainants, and the effect was at least to diminish subsequent
attendance. Also he told of a number of physicians with psychiatric interest
who would conduct informal talks about common personal problems with
patients on the wards.
The question of nomenclature does not seem to me to be too important
at this stage of development, although I can appreciate the point that group
psychotherapy should be limited to that in which physicians participate.
At the same time there are a number of group therapeutic activities in which
the physician can function best by being absent but not necessarily an
inaudible member. For instance, in many mental hospitals the Red Cross
can offer a neutral outlet for the patients to discuss common problems and
blow off steam, even against the hospital and sometimes it is not all steam.
Useful therapy, under guidance. I suppose we will have a problem with
lay group therapists such as the psychoanalysts, psychologists and social
workers have had, but Miss Herriott's presentation is an example of how
useful an intelligent, understanding and experienced lay person can be. As
an aside and apart, Alcoholics Anonymous has a better batting average
than any medical group with which I happen to be familiar. And I believe
I am also echoing the opinion of Dr. Lawrence Kolb, former Assistant Sur-
geon General of the United States Public Health Service.
There are also some workers who do not believe that group psycho-
therapy, aside from psychodrama, is of use to psychotic patients. Without
being a group enthusiast, I do not agree with this. Some of the earliest
group therapy work reported was on psychotic patients. More important,
a large proportion of psychotic patients tend to be asocial and to individual-
ize themselves to a pathological degree. Group therapy here is not only
of theoretical but of practical value.
Levy-Bruhl and Storch have emphasized the pathological implications
of "participation". This factor may have its uses, too, in group therapy-
just, as Dr. Meyer has pointed out, the catatonic reaction may have in the
individual patient, when we know more about it.
In treating the psychoses and psychoneuroses we know the importance
of having the patient take an objective attitude towards his problems and
symptoms. Group psychotherapy should be particularly useful in the
development of objectivity.
A major contribution of psychoanalysis has been the elucidation of
43
282 GROUP PSYCHOTHERAPY
the patient-physician relationship. Perhaps similarly, the development of
group psychotherapy, which admittedly is finding itself at present, may
give us useful information about the individual in relation to the group,
the physician in relation to the group, and the members of the group in
relation to each other.
44
GROUP PSYCHOTHERAPY
CAPTAIN FRANCIS J. BRACELAND, (MC), USNR*
Chief, Neuropsychiatric Branch
My function in this program tonight is to introduce the subject of
group psychotherapy as it relates to the military, and particularly to the
Naval, Service. Due to the limitations of time, this presentation of neces-
sity will be sketchy, and I shall rely on my confreres who follow me to fill
in the details and elaborate upon the theses which I can merely present for
your consideration.
Military group psychotherapy (1) as it is practiced today bears only
a slight resemblance to the group psychotherapy heretofore practiced in
civilian life. Born of necessity and used as an expedient in the early days
of the war, it has come into its own through the use of various innovations
and expansions as a technique for the treatment on a group scale of the
psychological casualties of modern warfare. The goal of group psycho-
therapy in military service is dear-cut and definite even if, when compared
with civilian group methods, it appears limited in scope. The primary pur-
pose of the military therapist is to get the patient well enough to return
to full combat duty. Failing in that, it is incumbent upon him to try to
return the patient at least to his pre-enlistment status so that he may re-enter
civilian life as an independent and self-sustaining citizen.
On the other hand, viewed from a technical standpoint, there are im-
portant basic meeting points between military and civilian group psycho-
therapy which merit attention. Such phenomena as the patient-doctor
relationships are common to every group. The manner in which certain
psychopathological reactions are interpreted and explained collectively is
comparable in either setting, Also the laws which govern group actions,
cohesion, and stratification are applicable to all groups. Whether the lessons
learned in military group psychotherapy will be applicable to the markedly
dissimilar situations which will be encountered in post-war civilian practice
remains to be seen.
I have stated that group psychotherapy in the military service was
*The opinions and assertions contained herein are the private ones of the author
and are not to be construed as official or reflecting the views of the Navy Department
or the Naval Service as a whole.
45
284 GROUP PSYCHOTHERAPY
originally used as an expedient. This implies a negative causality for its
use and hence is not sufficient cause for the continuation of a therapeutic
method once the emergency has been met. The question arises as to whether
the psychiatric emergency ever has been met or ever will be met. Pre-war
psychiatric therapy was available to only a selected few patients. It was
time-consuming and difficult and consequently capable workers were few
and but very few patients were treated the majority received no care. Most
military psychiatrists, equipped only with established civilian techniques,
soon found themselves faced with demands which they were unable to meet.
There was another fact which impressed itself upon the medical officers,
however, and that was the powerful influence and unifying quality of
mutual adversity. Men who have experienced numerous adventures and
hardships and have lived intimately with groups of comrades develop a
feeling of security and "belongingness" as members of a group. Here was an
opportunity for group psychotherapy to capitalize on this sameness of
experience and to unite a technique of expedience with one of election.
It would be interesting, therefore, to contemplate for a moment the
other factors which have operated to give impetus to the relatively wide-
spread use of group therapeutic methods at this particular time. Heretofore
psychiatry has been concerned almost entirely with the activities of the indi-
vidual. With extreme care and brilliant thoroughness, it has dissected the
various psychologic reactions of individuals under stress and utilized the
knowledge gained in various therapeutic methods. Rightly, it has considered
every patient as an individual, but the deficiency has been that sometimes
it has paid only lip service to the fact that individuals with or without
symptoms must live in a world composed of other individuals and groups
and influence, and be influenced by them. Not infrequently therapists were
confronted with the fact that patients who apparently had recovered and
gained insight while under treatment in sanitaria, relapsed shortly after
their return to their normal social milieu.
One answer to this phenomenon undoubtedly lies in the fact that no
person is an island apart from the mainland of social relationships. There
are for all persons points of mutual contacts and common meeting grounds
in which they must encounter their fellowmen. No matter how well inte-
grated the individual may appear to be, the fact remains that unless he can
take his place in the group or society in which he lives he will inevitably
develop psychologic symptoms which will indicate maladaptation. At the
46
GROUP PSYCHOTHERAPY 28S
present time under the military system, close relationship with one's fellow-
men is forced upon the individual; he has no choice. Just as war makes
bedfellows of various nations, which must unite for a common cause, so
also does it require individuals to unite with others to form groups in order
to give battle to the common enemy. Thus, military service provides a
natural, ready-made setting which encourages and invites the trial of
group psychotherapy.
In the first place, military patients have a great deal in common in
being all members of the military service. They have lived, trained, played,
travelled, and fought together and their presence in military hospitals for
the purpose of obtaining psychiatric treatment indicates that they have de-
veloped their presenting symptoms as a sequel to, or concomitant with,
their military experiences. Here then is presented an ideal, controlled situ-
ation for the trial of all forms of group therapy. The usual complicating
economic and disciplinary factors which sometimes interfere with civilian
attempts at controlled therapy are absent, for our patients can be kept under
treatment as long as the military situation permits and during treatment they
need not be concerned with the costs of medical care. These factors, plus
the apparent generalized growth in interest in social and group problems,
present us with an ideal opportunity to examine the possibilities and the
deficiencies inherent in group therapeutic methods.
One thing is understood at the start by the proponents of mili-
tary group psychotherapy, namely that its advocacy does not mean that
the treatment of individuals can be reduced to the level of stereotyped stand-
ardized uniformity. As much specificity as possible in the form of indi-
vidual interviews which supplement group therapy is, of course, desirable
for the patients under treatment. All that military group treatment hopes to
accomplish is to help each participant to define his emotional stability in
terms of the norms or values of his particular social and economic group.
Man adjusts or fails of adjustment and is stable or unstable not in a
vacuum but by reference to the specific values which his culture and imme-
diate group prescribe. Complete recovery in military medicine entails a
return to full combat duty a return to the situation which was responsible
or which was the exciting factor in the appearance of neurotic symptoms.
Failing in this, the military psychiatrist will settle for less, for it is recog-
nized that the return of an individual to civilian life as a functioning member
of society is an equally highly desirable aim.
47
2&6 GROUP PSYCHOTHERAPY
Group therapy sets out to accomplish its purpose not only by making
analyses of the nature of the deviations which concern the individual but
it also attempts to accomplish a successful synthesis, both psychological
and sociological. This attempt is made by approach to the patients through
their points of similarity, similarity of experiences, similarity of symptoms,
similarity of purpose. It presents material of common interest and of generic
validity to the group in order that each individual may participate and
personalize the more or less universal concepts which are set forth. It seeks
to utilize concepts which are readily recognized by the participants and, while
attempting to correct aberrant tendencies, aims to direct the individual to
the goal of normality, sometimes openly, sometimes subtly.
Inasmuch as military group psychotherapy is an over-all education for
social existence, a "round the dock" program is arranged on a twenty-four
hour a day basis in an attempt to prevent the patient from regressing to
an attitude of personal isolationism. Athletic, recreational and a masculin-
ized form of occupational therapy are utilized as adjunct therapies to attain
this end. Teamwork is stressed for it is symbolic of the attitude which
will be required when the patient leaves the hospital.
The Navy has found that audio-visual aids, particularly films which
subtly indicate that some psychological and physiological reactions are
common to all men, are of great value. Commander Rome (2) is collaborat-
ing in the preparation of a library of special treatment films (3) which will
considerably amplify the therapist's resources, as well as relieve the group
sessions of any danger of monotony. Thus far five films have been com-
pleted, and a study of the patients' reactions to them has been undertaken.
Finally and in the last analysis, the success or failure of group psycho-
therapy depends upon the therapist. The function of the therapist is to act
as a moderator or as a screen upon which the group can project its own
reactions. Any tendency toward delivering a monologue or a lecture must
be carefully avoided. The moderator must be alert to see that one extra-
vert does not monopolize the session and that no introvert, though physically
present, psychologically isolates himself. The approach to psychological re-
actions must be on a generic basis and the formation of symptoms clearly
and logically explained. If the moderator persists in translating the knowl-
edge he gained in the practice of individual psychotherapy to group therapy
with no regard for the psychological reactions and motivations of groups,
he will attain but minimal success.
48
GROUP PSYCHOTHERAPY 287
In closing, may I add that Naval psychiatrists make no untoward claims
as to the value of group psychotherapy, nor do they regard it as a panacea.
It is simply another valuable weapon in the psychiatric armamentarium of
the medical officer.
BIBLIOGRAPHY
1. Braceland, Francis J., "Hospital Corpsmen on the NP Ward," Hospital
Corps Quarterly, September, 1945.
2. Rome, Howard P., "Therapeutic Films and Group Psychotherapy,"
Sociometry, Volume VIII, No. 3-4, 1945.
3. Moreno, J. L., "Psychodrama and Therapeutic Motion Pictures," Soci-
ometry, Volume VII, No, 2, 1944.
49
GROUP PSYCHOTHERAPY AND THE PSYCHODRAMATIC
METHOD
BRUNO SOLBY, SURGEON (R), U.S.P.H.S,
Chief Psychiatrist, Mental Hygiene Unit
Employers Health Service, U.S.P.H.S., Washington, D, C.
Both advocates and sceptics of group psychotherapy have ascribed the
development of this therapeutic method to the increasing need for psycho-
therapy and the present dearth in trained psychiatrists to satisfy the de-
mands for psychiatric services. This mechanistic interpretation, which
ascribes the development of a new method to the dynamics of supply and
demand, disregards the economic law which states that whenever the supply
of certain goods or services is insufficient to meet the demands for them,
the substitute product or service is not one chosen at random but represents
a manifestation of new discoveries, of new orientations, which had remained
latent up to this time.
Does group psychotherapy offer a technique of practice based upon
an emergent theory, a new theory of man's mind in health and disease?
It is our conviction that it does. For concomitantly with a growing interest
in group psychotherapy we observe also, to an ever increasing degree, re-
formulations of principles in psychology which explain man's psychody-
namics in terms of his interaction pattern with the other members of the
group. The original psychoanalytic theory of man's mentation as a super-
structure imposed upon the biological organism in- struggle with society
has ceded ground to ego-psychology and the concept of basic personality
structure. Though lip-service has been rendered to various "social" theories
of man, the basic orientation continued to be rooted in biological principles.
Thus, those who advocate or even practice group psychotherapy have not
necessarily changed their primary orientation. The contradictory reports
as to methods used and results achieved are no doubt to be attributed to
this discrepancy between theory and practice.
Group psychotherapy is always "group" therapy. It is the group itself
that becomes the therapeutic agent as a result of the interaction between
the individuals who form the group. The psychiatrist who does not recog-
nize the therapeutic dynamics inherent in the interaction between the indi-
viduals forming a group has missed the boat. For, guided by biological
principles, he essentially distrusts the group and uses the group as a sub-
50
GROUP PSYCHOTHERAPY 289
stitute tool for the achievement of the therapeutic goal, by conceding to
the group the status of the herd whose libidinous attachment to the leader
(father, psychiatrist) is partly transferred to each member of the group.
This type of group therapy can be observed in many cults and "healing"
meetings. I have always been inclined to believe that only fear of either
latent or objectively observable dangers has induced individuals to subject
themselves to this primitive relationship. The leader of such a group usually
utilizes this fear and confusion of its members for his own end, whether
it be monetary gain, power or some other advantage he expects to accrue,
In this group structure the leader of the group assumes the healing function.
We hardly can call this procedure group therapy.
For group therapy should be understood as the psychotherapeutic
process which results from group interaction. The functions of the psy-
chiatrist therein are twofold: He controls by specific methods the degree
of spontaneity of the interaction process and, secondly, he acts as a catalyst,
in the interpretation of the group to the individual or of the individual
to the group. Such orientation implies that the psychiatrist, in the course
of his education and training, will have acquired a knowledge of social
dynamics in addition to his training in psycho-dynamics. There are
many indications that this course is followed by an increasing number of
students,
It is lack of this knowledge of the dynamics of the group that at present
limits the extent of this new therapeutic procedure.
Up to the present, aside from group psychotherapy as practised in
closed institutions, the selection of patients for this procedure has mostly
been based upon some kind of identity which existed between the individuals
forming the psychotherapeutic group. Various reports indicate that the
following three categories of identity between individuals have been used:
either the identity oj symptoms, such as we find in psychosomatic disorders
(and the majority of reports cover disorders of the gastrointestinal tract) ;
or the identity oj social status, which explains why attempts in group therapy
have been reported so frequently from the Army and Navy; or, finally,
the identity of a formulated goal, as we observe it in religion especially
in its institutionalized form. The results of these therapeutic attempts
appear to be proportionate to the degree of identity achieved in the indi-
viduals selected to participate in the procedure. This screening process in
the choice of patients represents a limitation which might well be caused
by the lack of adequate knowledge of the inherent dynamics of group action.
51
290 GROUP PSYCHOTHERAPY
As far as methodology is concerned we should like to advance the
criticism that the methods of verbalization and intellectualization to which
group psychotherapy is often limited do not seem adequate if group therapy
is to offer a technique for treating individuals who cannot be benefited by
the interview method. For verbalization and rotellectualization would pro-
ceed better under the immediate direction of an expert than when left to
the indiscriminate use by the group. Verbalization* as well as intellectual-
ization means the employment of socially significant symbols. But the emo-
tionally and mentally ill attribute to symbols a very personal and private
meaning. /The method therefore, if it should offer us advantage over those
in use upno the present, should include means of communication that might
be described as pre-verbal and which we find represented in gestures or
non-verbal action patterns. These, too, often represent symbols, also socially
significant, and could help the individual to communicate himself to the
others and thus to transcend his isolation. With children play therapy has
been used for this purpose; for adult patients we see in the psychodrama
the method which adds meaningful action to communication on the verbal
level. * " ~ ~ ~~
The use of the psychodramatic method in group therapy will be
described to you by the other speakers. I should like to discuss with you
briefly the application of this method in a training program for personnel
workers, such as employee counselors, placement officers and so on, in
government departments where a more scientific approach to personnel prob-
lems was demanded.
In lectures to them on psychology we presented the role as a concept
both sociologically and^ psychologically valid, and developed this theory to
explain action patterns" especially the mteraction patterns between the indi-
vidual and the group^ We also attempted in these lectures to relate patho-
logical behavior forms, as well as their etiology, to various role patterns.
In connection with these lectures I felt, however, that some type of
psychological laboratory practice would be of value in demonstrating per-
formance patterns. The technique used was Moreno's psychodrama, in
which various roles as they manifest themselves 'Hi tiUtiClflt! JillWiLlUJWj Wre
acted out; group discussions followed in which the psychological and socio-
Iqgical aspects of the performance were analyzed. We also demonstrated
the emergence of a rigid role, as well as its interference with the execution
of assignments. It was stressed that the industrial act takes place between
the employee and the supervisor and that personnel workers function in an
52
GROUP PSYCHOTHERAPY 291
advisory capacity only. This implies that their function is mainly catalytic
and has to be based upon a thorough understanding of the situations that
arise between the employee and his supervisor; their grasp of such situa-
tions was tested by their ability to take the roles of the employee and
also those of the supervisor. Factors which interfered with their acquittal
of occupational duties became apparent in such laboratory demonstrations
and the group discussions which followed.
The results of the program have been very encouraging. They might
be described as: better understanding by personnel workers of their responsi-
bilities as well as of their personal problems; improved analysis and com-
prehension of employees' problems; more adequate selection of employees
who need mental hygiene guidance and referral to our clinic. Emphasis in
these lectures and demonstrations was not only upon the demands made by
the employer in this case, the Federal Government but was more broadly
related to the demands imposed by our industrial society, with its socio-
economic and cultural patterns.
Though offered as a laboratory practice it undoubtedly had very definite
therapeutic implications which were reported by a number of members of
the group as a feeling of "loosening up" and the experience of improved
interpersonal relationships; they ascribed this to an increased feeling of
spontaneity and a re-evaluation of their performance on the job. Yet un-
doubtedly it was the ultimate performance on the job, in the actual job
situation, which represented the final phase of the therapeutic procedure.
This result represents also the limitation of every psychotherapy, whether
it be group or individual. For I have never claimed that my patients recov-
ered either in my office or on the psychodramatic stage, but have believed
that the therapy enabled them to ^^dpateVn the social act of the group
of which they were members and that as a result of such participation they
achieved mental health.
S3
SOME USES OF PSYCHODRAMA AT ST. ELIZABETHS HOSPITAL
FRANCES HERRIOTT
Theatre for Psychodrama, St. Elizabeths Hospital, Washington, D. C.
For over three years Psychodrama has been among the various forms
of psychotherapy in St. Elizabeths Hospital. It is carried on by the joint
efforts of the hospital and the American Red Cross and has been found very
effective in dealing with some of the problems of the about~to-be-discharged-
service-patients and their return into civilian life.
Patients are selected for psychodramatic treatment by the physicians
(or social workers or patients, with the approval of the doctors). They come
to the theatre and, with the guidance of the director and staff, act out situa-
tions dealing with interpersonal relations and social problems. These scenes
are "spontaneous and unrehearsed/' but each one is carefully planned to
fit the needs and interests of the participants. The audience is made up of
patients, Red Cross helpers who are trained in psychodramatic techniques,
occasionally physicians and psychiatric social workers.
In an informal and friendly atmosphere on a circular stage especially
designed for this work, family, hospital, service and re-employment problems
are presented. Each scene is usually followed by a vigorous discussion.
At the time patients are referred, they usually feel very insecure
and are emotionally unstable. From their case histories we know that
many of them haive gone through very harrowing experiences, while others,
even before any atebwl combat, have not been able to meet or adjust to the
demands of military life. After a breakdown of this nature they are often
afraid to encounter ordinary everyday situations and they feel they are
"failures." With Psychodrama we try to help them regain their self-confi-
dence and to strengthen^ their faitfr In tfreiy own ahjjiHgg
^'To begin witn very simple situations are chosen, such as going to a
grocecy store. A few tables and chairs are arranged to suggest a counter
in thfc store; a staff worker or another patient who may volunteer be-
-^-_^ 7 r J
comes the clerk and the scene begins. Always the patient must be care-
fully watdied to see that things do not get too much for him. He must not
jail during his first few scenes on the psychodramatic stage. If he shows
any signs of floundering someone must go in and support him. Only situa-
tions which he can successfully bring to a conclusion must be tried. Later
on, when he feels more sure of himself and seems ready to meet more diffi-
54
GROUP PSYCHOTHERAPY 293
cult situations perhaps even competition he can be presented with more
involved scenes.
One of the problems, which seems to be most common among the con-
valescent service patients, is: "What am I going to tell people when I get
home how can I explain being out of uniform with the war still going
on if I had lost a leg or something!" In a short interview with a patient,
John Doe, we learn that his "family will understand" for they have visited
the hospital, but the "nosey neighbors will want to know why I am out of
service and at home" We suggest a scene in his home town, at tbe Post
Office where his mother has sent him to mail a package. While the patient
is involved with the business of mailing the package, a staff worker in the
role of the "nosey neighbor" enters suddenly upon the scene and addresses
the patient by name. "Why, aren't you John Doe? I didn't recognize you
at first I thought you were in the Navy. Are you home on leave?"
There are innumerable ways of meeting and answering this inquiry, de-
pending on the relationship of the person who puts the question to the
patient. He may reply that he has been discharged from the service (honor-
able discharge) and is now "just at home"; or (if pushed by the staff
member) he may tell of his breakdown, his hospitalization and recovery.
One particular John Doe folded up when confronted by this question and
it was several sessions before he could make an adequate response. Such
scenes usually lead into a general discussion among the patients in the
audience, and many fears are ventilated as the patients discover that their
worries are shared by others. On one occasion a patient remarked that he
would tell people that it was "none of their business" why he was at
home, so we gave him an opportunity to do just that. The scene was in
the drug-store, and as the soda clerk (a patient or staff member) was
polishing a glass, he asked," How come you're not in uniform?" The patient
turned to give his retort and found that it was more difficult than he thought
to reply, "it's none of your business," thus learning from actual experience
that there were perhaps better ways of solving his problem. In reality each
individual will have to deal with this situation for himself when the time
comes, but in preparation for that moment, he can, in the theatre on a spon
taneous level, rehearse for real life or watch others meet similar situations
or, by reversing the roles, to get a grasp of his situation as a whole, he
can play ,one of the people "back home."
Another type of scene we have found helpful to patients who are abdut
to leave the hospital are those dealing with employment. In some instances
55
294 GROUP PSYCHOTHERAPY
a detailed description of the nature of the illness, or reason for discharge,
may be necessary. We set up an employment or personnel office. UsuaJly
a receptionist meets the applicant (a patient), inquires his reasons for
coming in, and directs him to the office. In the employment interview, new
vocational interests often come to light and are discussed freely. If we have
anyone in our audience who has specific knowledge of a particular vocation
mentioned we can use him as the interviewer.
On one occasion, a young sailor with only a high school education and
a few months service in the navy said he would like to work in an electrical
engineering firm. When challenged as to the likelihood of his getting a
job with his lack of training, he said that he could be a "blue-print boy"
and take a course of training while working. At that session there was in
the audience a patient who had never played a role on the stage, an officer
who was a graduate from a mechanical engineering school in a big uni-
versity. This officer was asked if he would take the role of the personnel
manager of a big electric plant and interview the applicant. He agreed
and went up on the stage; the boy entered and the interview began. Ques-
tions of training experience salary living quarters and draft status were
discussed. It was a very real scene the interest growing as the scene
progressed. The straightforward manner in which the boy explained that
he was 4-F because of a medical discharge from the service did much to
convince the "personnel manager" of his recovery and his present ability to
start out again in a civilian job. When the scene was over the boy came
off the stage with a feeling of accomplishment. The officer, too, was bene-
fited for he felt he had shown himself as a person of importance, not a
"failure." This brought stimulus to both of them; their shyness disappeared
and an eagerness to tackle further scenes was aroused.
The case of Mary Doe, a Navy Nurse with 17 months' duty before
her hospitalization illustrates another angle of this same problem and how it
was worked out in psychodrama.
Mary was worried about being able to get a position as a nurse in a
hospital after her discharge from St. Elizabeths. "Everybody knows what
kind of hospital St. Elizabeths is 1" We made up scenes in which Mary
applied for jobs other than in the nursing profession; scenes in which Mary
as an office nurse had to see an applicant for the job of telephone operator,
and during the interview the applicant revealed the fact that she had re-
recently been discharged from a mental hospital; Mary applying for a job
in a hospital and being questioned concerning her training, experience and
56
GROUP PSYCHOTHERAPY 295
reason for leaving her most recent position; and then Mary in the role of
a Superintendent of Nurses, confronted with numerous problems, including
seeing a young woman (staff member in the role of Mary) who has come to
apply for a position. In this last scene, Mary listened to the applicant's
story (her own), hesitated, and then inquired whether the applicant felt
fully recovered and able to resume work. On receiving an affirmative
answer, Mary decided to give her a try. Two months elapsed after Mary's
discharge from St. Elizabeths when we received the following letter: "I
know you will be interested in how the 'situation' was presented and met.
It wasn't so bad I had to fill out the application blanks and answer ques-
tions just like the scenes on the stage, and I am ever so grateful to you and
Miss Pie for all the rehearsals. They really fortified me for the occasion.
I want you all to know that your work and effort was not in vain." This
letter was augmented by another, six months later, to report all was going
well with her; she was working in the same hospital and enjoying life in her
new surroundings.
The fields in which Psychodrama and its various techniques may be of
value are many. As a form of treatment combining group therapy with 1
Drama it is extremely flexible for it can be adapted to almost any sociS
and age level. It is probably a little early to make any statements about
the lasting effects of this form of group treatment, but from the many letter*
received from former patients, we know that Psychodrama has been helpffil.
57
PSYCHODRAMA IN A CHILD GUIDANCE CLINIC
LOUISE A. SULLIVAN
Duke University Hospital
Psychodrama was started at Duke University Hospital in 1943 and
the following will illustrate some of its applications. Patients who are ad-
mitted to the psychiatric service, whose post-hosp'italization plans might
be aided by psychodrama are given over to the dramatist for the last few
days of their hospital stay. Through the media of an actual stage, trained
helpers, or by means of a dramatic interview technique, their problems are
worked upon and the patients are enabled to return to their environment
with more security.
A questionnaire has been devised, called a psychodramatic social his-
tory, which is made up of situational questions used at the discretion of
the psychiatrist to bring about a procedure of rapid rehabilitation of the
patient's practical and conscious problems. It is from the result of this
questionnaire that the situations the patient acts out in his psychodramatic
course are derived. The major portion of the writer's work with psycho-
drama was carried out in the Child Guidance Clinic connected with the
Department of Neuropsychiatry. This paper for the most part will be writ-
ten around psychodramatics with children.
The value of play technique in the treatment of childhood behavior
disorders is well known to the psychiatric field. However, psychodrama
has another advantage. Having only the child's imagination and problems
as props, it is a simple matter to put his problems on a reality level, thus
offering him active treatment from the time of his first clinic visit. In
bringing into play this unique quality of spontaneity, the patient is revealed
to himself and helps remove the need for self-deception. It is a dynamic
inter-play of the interpersonal relationship, which the child can accept for
himself as truth, because it is himself in action. This freedopa of action
was not granted to children until recently; the child was brought to the
Child Guidance Clinic, tested, measured, and questioned but was given
little opportunity to express himself in his own way through the medium
of play. This method provides a wealth of general material within a brief
space of time, and has the advantage of allowing the psychiatrist to treat
the child and his problems immediately rather than having to wait until
rapport is established to develop the treatment through the medium of
direct conversation. All children dramatize in their play their inner needs,
58
GROUP PSYCHOTHERAPY 297
compulsions, and interests. Spontaneous play centers around those life
activities which they have most recently observed, those which have made
the most vivid impression upon their young minds, and those with which
for some reason they happen to be concerned at the moment. [Play habits
have too important an effect upon a child's subsequent development to be
allowed to develop entirely undirected, and although a child's play should
not be adult-dominated, it can, through the wise use of psychodramatics,
be guided along lines which have definite benefit to the child and his future
adjustment. Therefore we may assume dramatic activity is merely the out-
ward manifestation of the child's innermost thoughts and fantasies. Basic
neurotic traits are expressed when the child is free to engage in spontaneous
play, and an experienced observer can obtain much information regarding
the mental health of the child simply by studying the child's spontaneous
play activity.
It is our purpose in psychodrama to discover conflicts in children wlftj
are preoccupied in any one form of activity or thinking, and through such
discovery, to give them all possible help in enabling them to free themselves
of any conflicts, thus helping them to advance more wholesome interests.
We do not intend to increase the child's neurotic behavior by encouraging
those play activities that tend to aggravate the original disturbance, but
rather to direct his activity to a more normal and outward channel. Dramatic
play that is motivated by neurotic thinking can be directed so that it will
lead to a solution of the emotional problem through encouraging wholesome
play activities, which, at the same time, are socially acceptable to the group
in which the child has to live. A very important thing to remember is that
children need help and protection against over-stimulation and that they
should not be encouraged in their preoccupations. A wise use of psycho-
dramatics can do this.
Whether or not a child is to be treated by psychodramatics is based
largely upon the psychiatrist's interview. Results of psychological tests
and the individual child's needs play an important part in determining
whether this method should be utilized. If psychodrama is the method of
choice, the child is started in a group which is suitable to his needs, or is
left to the dramatist alone, depending upon the nature of his conflict and
problems. The child is aftem^d^^t toough,, a, series of, situations .suited
to bring outTEe cpre^pf his problems. These standard situations cover the
entire gamut of his interpersonal relationships to his family, to his friends,
and to society in general.
59
298 GROUP PSYCHOTHERAPY
In choosing a group of standard situations which could meet the needs
of every child and are not too time consuming, all the important aspects
of a child's life are considered. It is very important to know the measure
of a child's fantasy life. This is accomplished by means of fairy tales and
games, because in these activities children very often show their opinions
and problems, giving the therapist a due to what is troubling the child. In
this fashion some outline for future therapy may be made.
It is also important for the therapist to know how the child will react
to the managing adult, how he will react to the group in general, to indi-
viduals in particular, to know what influences he seems to accept or reject,
and how he reacts to just and unjust punishment. This can be carried
out by initiating scenes in which a certaiii form of punishment is evoked,
to see how the child reacts to the punishment and to the parent giving the
punishment. Scenes are devised which will give some clue as to how a child
reacts to reward, appeals, withdrawal of love, challenge, and to self-discipline.
Other situations have been devised to see what technique the child
has made up to handle responsibility and how he alibies to himself and to
others. Certain scenes will show how a child manages the demands of a
group, and individual members of the group; others will show the
effect of gang psychology in his thinking and acting. The person who is
planning a psychodramatic course wants to know the child's ability to
handle feelings of aggression toward father and mother, the reactions he
has towards adults in general, his management of sibling rivalry (seen in
so many children who have problems) and wants to know in general how
these children act in any normal situation.
This last knowledge is used as a control in studying his abnormal
behavior and thinking, which can only be known by devising situations
through which the child may act spontaneously what he feels at the moment.
This can be done by putting him into reality situations covering these points.
In these scenes which the children are playing out, the other children consti-
tute part of the scene or are present in the audience. By the therapist's han-
dling of the unconscious basic fears that each child has as they are encoun-
tered in psychodramatic activity, the child is given much more security
against the time when he next encounters this same fear.
The spirit of competition in the group helps to stimulate the play, and
caa be used as a very valuable asset in treatment. This may be done by
putting the shy child first into a younger group, which permits him to be
the most aggressive person in the group, and then, as improvement is shown,
60
GROUP PSYCHOTHERAPY 299
by putting him into a group of his own age, where there is a more "give
and take" relationship. If we feel that a child's problems center around
one person, e.g., parent or teacher, the child is kept in the dramatic situa-
tion with the therapist alone, thus allowing the child to identify the therapist
with the individual toward whom he has feelings of aggression.
By way of illustration, the case of Barbara, a fourteen year old girl,
is cited. This youngster was brought to the Clinic because of the difficult
home Situation which she was creating through her inability to accept any
form of discipline. This trait also manifested itself in her school activities.
Her need to dominat^ any situation in which she found herself ultimately
led to her being completely friendless. In this case the technique of "reversed
roles" was employed. The child was persuaded to play the roles ~of mother
ana teacher, ana in this fashion was given some insight into the problem
she herself presented, because she could thus see herself in a more objective
fashion. In this particular case the technique employed was successful.
She had sufficient insight and intelligence to apply what she had learned
from the play situation to her own life situation.! Through the medium of
psychodrama she was reassured about the anxieties which she displayed,
and upon discharge from the Clinic, her aggression had disappeared to the
extent that she had become socially adaptable and was assimilated - into
the conventional patterns of her own age group. In this case the mother
was also under treatment, and quite soon a reasonable solution to their
problems was achieved, whereas under ordinary methods, much more time
would have been consumed in the establishment of rapport, exploration,
and the working out of some reasonable solution to the problem.
The psychodramatic technique possesses an initial advantage over
other therapeutic approaches with children in that children naturally tend
to dramatize their life situations. Another advantage is that through this
medium the child finds himself on a level of equality with the adult worker,
who, prior to this time, would have constituted in the child's eyes principally
a disciplinary force. | In the case of children who have not had good relation-
ships in the past with adults, this new relationship with an emotionally
stable person helps them resolve their inner fears and conflicts. Another valu-
able tool in the psychodramatist's hands is an ability in the play situation
to evoke from the child a lability which will carry over into everyday
activities. One thing which should be constantly borne in mind is the
recognition of a child's own interpretation of his play activity, because in
61
300 GROUP PSYCHOTHERAPY
this fashion we may learn what method he has chosen for handling his
conflicts and aggressions.
In studying and working with a large number of children by means
of psychodrama, it was found that they all gave evidence of certain fairly
typical reaction patterns. Each child goes through an initial period of
resistance, which is nothing more than an expression of the aggression he
feels toward the dramatist as an adult. This may be handled in various
ways, depending on the type of youngster with whom one is dealing. The
initial resistance is generally followed by a period which is characterized
by the encouragement of spontaneity by the therapist. This is done by
permitting the child to elect his own topics of conversation, to express his
own interests, and to choose his own play and companions. The dramatist
tries to keep the child at this time on a neutral level where his problems
are not brought 'into the foreground. This is followed by a period of sug-
gestion, where standard situations are set up for the child. An effort is
made then to determine the child's difficulties. The standard situations are
built around such things as wish-fulfillment (which may be acted out
through the medium of fairy-tales), the playing out of future ambitions,
and a gradual evolution of plots which show definite interpersonal relations.
The fourth stage is known as the planned-therapy stage, where the actual
work is done upon the problems, namely, encouragement of aggressive acts,
and utilization of material which was found during the exploration or
suggestion period. From this time on the child brings out more and more
material bearing on his unconscious problems. This material is utilized .in
the way which will be most beneficial to the individual patient.
No child is treated unless the parents are being carried on a psycho-
therapeutic basis by another psychiatrist, because the parents must develop
insight into the basis of the child's problems, and be able to carry on treat-
ment at home, once the child is discharged from the Clinic. It would be
very unwise, for 'instance, to let a child have an hour of aggressive, un-
inhibited play each week, if he must return home to face the same situation
which precipitated his problems.
We have found in our work with the Child Guidance Clinic, that chil-
dren fall roughly into one of three main groups. The type most frequently
seen is the over-inhibited child, wh^ reacts to his internal conflicts by
means of terror dreams, anxiety attacks^'in some cases, develops physical
symptoms manifested by feeding problems, nail-biting, and other neuro-
pathic traits, sleep difficulty, and perhaps tics. Very frequently this kind
62
GROUP PSYCHOTHERAPY 301
of child is shy, seclusive, and in general seems to demonstrate an undue
amount of introversion. In many instances the parents are also found to
indicate certain typical behavior. The mother is usually over-protective and
over-restrictive, probably because she is compensating for some parental
rejection in her own life. The father may be intolerant, and a perfectionist
Both parents together may show a lack of consistency in handling the be-
havior problems of the children. As a consequence the child is forced,
through his own fear of parental rejection and loss of love to be "good",
handling the aggressive feelings which he has by retirement into neurotic
behavior.
Typical of the above-described group is the case of Phillip, a six-year
old boy, who was brought to the Child Guidance Clinic because of the sud-
den appearance of facial muscular tics. In addition he had a long-standing
problem of inability to socialize with children his own age. Phillip's mother
was a typically over-anxious parent, who was always shielding her son from
any possible danger, openly commenting on his neuropathic traits, and dis-
cussing his tics in front of him. Because of her over-protection she did
not permit him freedom in mingling with children of his own age in natural
play activity.
This case was handled by having the psychiatrist work with the mother
upon her own problems of insecurity, with strong suggestions that she leave
her son to his own devices, even though potentially these might involve
some physical risk. The child was placed first in a group younger than
himself, where he was permitted to be the leader. Next he was placed alone
with the psychodramatist, where he was encouraged to work out his anxie-
ties and aggressions with her as the identifying factor. Through gradual
steps he was allowed to enter a group which was older, where, through
competitive activities with other children, he became a normally socialized
individual.
Another type of child frequently encountered is the aggressive, anti-
social individual, who is referred to the Clinic mainly by the Court, school
authorities, or juvenile delinquency agencies for evaluation. In general no
effort is made to treat this kind of child because nothing is gained by further
encouragement of his aggressive behavior through psychodrama, and he can
only do harm to the group in which he is placed. This child's parents are
usually not interested sufficiently in the child to come to the Clinic, and
are not available for concurrent treatment. By way of aiding the child to
respect discipline and the rights of others he is placed in a school or insti-
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302 GROUP PSYCHOTHERAPY
tution which deals with problem children, and where these basic principles
are enforced. Upon discharge from such an institution, he may be carried
by the Clinic on a supportive basis.
To illustrate, we cite the case of Randy, an eleven year old, who was
referred by the Juvenile Court because he was suspected of being the leader
of a gang detrimental to his community. Because of this boy's innate intel-
ligence and ability to get out of situations which might involve him unduly,
he was sent to us for exploration. He was Immediately enthusiastic about
thtf Clinic, came voluntarily, liked the people he met, and within a few
weeks asked if he might bring his whole gang. In seeing Randy in relation
to the gang, it became evident that certain situations could be planned which
would give indication of whether he was actually the group leader. One
situation was set up in which a bicycle was to be stolen from a store win-
dow. Another time the boys were permitted to outline plans for blowing
up a factory. Another instance involved the infringement of a school rule
and expression of the means for avoidance of blame. In about eight out
of ten such situations it was readily evident that Randy was the most
resourceful, the initiator and planner of all the activities, that the gang
was merely followers and Randy the leader. We were consequently able
to give sound recommendations to the authorities on how this particular
problem could be handled.
The third type of child may be characterized as "pseudo-social" in
that he has conflicts with his group and with society in general, resolved
by the committing of asocial acts, which have not yet reached the point
where he would come in conflict with juvenile authorities.
An example of this kind of behavior is the case of Frances, an eleven
year old girl, who was referred to the Clinic by a group of concerned
neighbors and teachers. She had been seen on several occasions in acts of
sexual perversion involving an animal. Frances was the second of a family
of three children. There was a definite history of long-standing parental
incompatibility. This child had been rejected, not only by her parents, but
also by her own social group as a consequence of bringing into play the
unhealthy attitudes of her parents, manifested by swearing and bickering.
Another contributing factor was a parental verbal promise of a dog to the
child as a reward for her good behavior. This promise was never kept, and
the child was subjected to a constant resulting disappointment. All these
factors together produced a very frustrating search for security and love,
wMch her parents and group did not afford her.
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GROUP PSYCHOTHERAPY 303
The chUd was carried by the Clinic for a period of ten weeks. When
,he entered the Clinic she presented the picture of a very shy, withdrawn
* M unable to make contacts with either children or adults in the Clinic.
^as discovered that she had been a thumb-sucker since birth, although
fact was not reported by the parents. It is interesting to note that she
'to the Clinic very faithfully, and would remain, even though she did
articipate in any activity. The following will show the mechanisms of
feychodramatic approach in this case.
t-or an initial period of three weeks the patient showed a very definite
'nee to the group and to the dramatist, which was handled by leaving
e, not forcing her into any group situation, but by making play
and books available to her. During this time she constantly made
.als out of clay material and her book interests were along the lines
. Dr. Doolittle's animal stories. After the period of resistance wore off,
she began to affiliate with a group which was younger than herself. In this
group she was domineering and was able to carry it off, due to the fact
L hat she was an older child. Thus she acquired a rather precarious
security, which even so represented an improvement over her previous con-
ition. Subsequently she gained a good rapport with the dramatist. During
iis time she gave some description of her preoccupation with animals and
frequently made indirect and somewhat derogatory references to her parents.
At the sixth week of treatment she was gradually put into standard
group situations, where she would be the most prominent member of the
jroup. Here she gave evidence of definite sibling rivalry, specifically,
,ealousy of her sister, and a hostility toward her younger brother, which
took the form of actual planning of accident situations in which he would
be killed. Here she also showed the lack of consistency of treatment which
her parents had displayed toward her, and in her psychodramatic acting
she would play one parent against the other, in efforts to gain affection and
reward. She simultaneously demanded affection from the psychodramatist,
and made up situations in which she expressed her fantasies of the drafha-
tist as an ideal parent. In cases where her wishes were fulfilled the thumb-
sucking stopped altogether.
During the eighth week of therapy, an interest in sexuality other than
expressions of sexual preoccupation with animals was more openly demon-
strated. It was discovered that her menstrual periods were about to be
established. She had had some cramps and one instance of spotting, which,
since she had been told nothing about the function, had given her much
anxiety.
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304 GROUP PSYCHOTHERAPY
t
Having determined the causative factors of this child's problems by
means of psychodrama, it was decided that this approach had served its
purpose, and from that point on, the therapy consisted of social hygiene
talks, advice as to her personal relations to her group, and concommittantly,
strong suggestions to her parents that they show more affection toward her,
and that they give her the animal which they had promised her.
Following her discharge from the Clinic, return visits showed a very
marked change in the child. She had given up her thumb-sucking entirely.
Sfee had become a member of the Girl Scouts, in which group she seemed
to.be well adjusted, and demonstrated more affection toward her family as
$ whole. Her parents had given her the dog, and this seemed to round out
her happiness.
In summary, the perverted sexuality in this girl's case seemed merely*
a symptomatic manifestation of her inner conflicts, centering around hei
need for affection, her awakening sexual curiosity, and her misguided idea\
of methods by which she could effectively dominate her group, in whic ,
she had a most insecure position. It was definitely felt here that althoug] .
the g'irPs problems could have been ultimately resolved by any competeiT
therapist over a long period of time, the psychodramatic techniques af ords , ,
a comparatively rapid method of solution of her conflicts. In any such ca* ,
of therapeutic contact, a certain amount of transference is inevitable
Through the psychodramatic method, however, we were able to give the
girl back to her group without a resulting feeling of loss and deprivatior^
on her part. * * * ' M
In this paper we have attempted to show how psychodramatics may bt
employed in the study of interpersonal relationships and as a therapeutic
device. Work along these lines has been carried out, mainly in the CMild
Otidajjca Clinic affiliated with Duke University Hospital.
It was found ffi^the*eM<te wfio are reterflSTTo the Child Guidance
Clinic fall generally into three main groups: (1) the over-inhibited child;
(2) the aggressive, anti-social child; and (3) the "pseudo-social" child.
The children under observation manifest certain fairly typical reaction
patterns. There is an initial period of resistance, followed by a so-called
spontaneity period in which a relationship is established with the therapist.
Next comes a time when standard situations are set up for the child, and
an effort made to determine his difficulties. The final stage is the plafined-
therapy period, when the actual work progresses upon the problem, both
in relation to the child and to his parents.
66
GROUP PSYCHOTHERAPY 305
During the course of this work, certain broad principles seemed evi-
dent: (1) that dramatic activity is merely the outward manifestation of
the child's innermost thoughts and fantasies; (2) that by the therapist's
handling of the unconscious basic fears present in each child as they are en-
countered in psychodramatic activity, the child is given much more security
against the time when he next encounters this same fear; (3) that through
the situation in which the child finds himself with the dramatist, he is al-
lowed to identify the therapist with the individual toward whom he has
feelings of aggression and thus resolve these feelings. \
Almost without exception the children treated become more socially
adaptable and a reasonable solution to their problems was reached in a Jar
less time-consuming way than would have been possible with other thera-
peutic methods.
67
GROUP PSYCHOTHERAPY
SAMUEL B. HADDEN, M.D.
Philadelphia
The participants in this symposium have presented several methods
which they have used to exert psychotherapeutic effect simultaneously on
a large number of mentally ill and maladjusted persons. The inclusion of
a [paper on the prevention of mental illness through a visual educational
effort is a healthy sign. The great interest in group therapy is indicated by
fjie fact that this symposium was scheduled to be held in a room which
would hold seventy people; its transfer to the largest room available was
made necessary by the great number of persons wishing to attend.
An historical review of the utilization of group psychotherapy would
undoubtedly lead us to antiquity where all leaders of thought endeavored
to influence men to a better way of life. As psychiatry has advanced the
therapy of the neuroses has reached a point where large numbers of those
disabled by neurotic illness may be cured. Individual therapy is so expen-
sive and so time-consuming that it is often beyond the means of many people,
and seldom is adequate individual therapy available in free dispensaries. Just
as if insulin were still selling for the prices that were paid in 1924 many dia-
betic patients would be unable to afford treatment, so the group method of
psychotherapy can make adequate treatment available to larger numbers and
consequently bring efficient psychotherapy to persons unable to afford treat-
ment under present systems. Although availability for greater numbers is
important, I believe that we should not place emphasis upon this factor
but rather upon the intrinsic value of group treatment and the points of
superiority of the method over treatment on an individual basis,
i Normal man does not exist in isolation but functions as a part of a
community. His actions influence the group and his failure to contribute
or to function adequately is a group affliction as well as an individual short-
coming. The aim in treating the maladjusted individual is to restore his
ability to live with 'and to contribute to the group. In the traditional indi-
vidual therapeutic relationship the patient relies upon the resources and in-
fluence of himself and the therapist alone to improve his adjustment; in
the therapy group the patient soon sees himself as an individual in relation-
ship to society, with the therapist occupying the symbolic position of the
68
GROUP PSYCHOTHERAPY 307
wise and just parent and the group as an understanding and encouraging
society. The individual neurotic, as a rule, regards himself as an unusual,
different and miserable person, incapable of living a happy existence in
society. The very feeling of isolation may account for his greatest anxieties.
Everyone who has used the group method soon realizes that one of its most
valuable assets is that it soon helps the patient to lose the feeling of isolation.
In our use of the group method we have utilized a technic which might
be termed an informative, analytical, reactive method. At each weekly session
we present briefly in simple language some fundamental psychodynamic
principle, illustrating it by common examples. This initiates active discussion
among the group, at which time the therapist draws from the members
acknowledgment of recognition of the workings of these various principles
in their own cases. At many sessions the case of a member of the group
or a typical history is presented very briefly for discussion; by this method
the patient vicariously identifies himself with the particular case under dis-
cussion, and it has been a frequent experience to have a half dozen or more
in attendance express appreciation after the session for discussing their par-
ticular case. In this manner the shy individual may experience some vicari-
ous catharsis.
We ask all patients admitted to the group but do not make it com-
pulsory to supply us with a written history which includes a description
of their symptoms, their childhood and general background, with a request
that they supplement this as they acquire additional insight. Many patients
refuse to comply with this request at first but usually do so after they have
attended several sessions. At all times during the group discussions the
therapist directs the answering of most questions to the group. Frequently
we ask each person present to answer the question even the one who pre-
sented it. In this way each patient is given the opportunity of reacting to
the situation under discussion. Many times, when given the opportunity
to do so, patients will discuss their own situations freely and identify them-
selves with others in the group; on these occasions every encouragement is
lent to a deeper discussion by those with similar problems and views, as well
as by those who hold opposite views. These discussion periods are simply
guided by the therapist to unearth material deemed to be helpful to those
present. It is in these periods of free discussion that patients have an oppor-
tunity by comment of activating some of their feelings of hostility and of
ventilating repressed thoughts and desires. This obviously occurs even when
69
308 GROUP PSYCHOTHERAPY
patients only listen, for they react emotionally to situations under discus-
sion, and often patients who remain silent show evidence of intense emotional
reaction and apparently obtain aid in acquiring insight by having problems
which are bothering them discussed so freely, At times these sessions are
dramatic and the reaction of the patients is therapeutically useful. We en-
courage all patients to verbalize their feelings and to participate in discus-
sions but it is obvious that even without doing so they are influenced in
their passive roles. We have had the experience of having patients acquire
insight rather abruptly in the group, without disturbing effect. This has been
particularly true in a group made up of parents of problem children. Many
have acquired appreciation of the effect which their attitude and behavior
have had upon their children without becoming offended at the therapist
and discontinuing therapy. In dealing with the neurotic parents of problem
children we have found the group method most useful and I feel that one of
the future applications of this method will be in parent education and in
the fieFd of child guidance. The presence of other parents with similar prob-
lems seeking understanding enables the parent to accept his faults and to
acquire an objective attitude much more readily.
In group sessions all of the principles employed in individual therapy
seem to have added emphasis lent them by the group spirit. There is un-
doubtedly a strong transference active in the group toward the therapist
but this transference is spread to the group as a whole and possibly to indi-
vidual members of the group. I have experienced very few occasions of
annoying transference from members of the group. Despite the fact that
we request all questions be asked before the group some infantile members
seek individual attention after the sessions. We then request that such
questions be asked before the next meeting. When this is done the group
is requested to give the answer and the infantile person has to join in the
discussion, and usually benefits far more than had it been aswered by the
therapist. No one has persisted in asking inappropriate questions because of
the mildly censorial comment and hostility which silly questions evoke from
other members of the group.
In all of our groups we have accepted new patients at each weekly
session. By doing so we have been afforded the opportunity of repeating
certain fundamentals frequently. Our cases have not been selected and
divided according to symptomatology but all have been grouped together,
our only restrictions being that patients referred to the group shall under-
GROUP PSYCHOTHERAPY 309
stand English well, that they shall possess no objectionable traits such as
tics which might be disturbing to the group, and they must be emotionally
reactive. At each session a brief presentation of the purpose of the group
is made with emphasis upon the necessity of persisting in the efforts to
acquire understanding through education. We have encouraged our patients
to discuss material presented at the sessions as freely as they wish outside
of the group, but have encouraged them to bring before the group individual
problems and questions. All of our groups have been mixed except for one
recently formed to deal with men separated from the services for psycho-
neuroses. Here the wives and even sweethearts of the members are en-
couraged to attend and seldom have we had a session at which several women
were not present. Despite the mixed group discussions of sex problems have
been free and without obvious restraint and apparently with benefit.
Following several weeks of attendance it is usual for individuals in the
group to begin to report improvement in their outlook and disappearance
of visceral symptoms. At each of our sessions we ask patients to state
briefly on slips of paper any change in their condition since the last session
or to ask any question they would like to have discussed. This gives us
the opportunity of using the reports as a basis for potent suggestion, and
the questions supply information about the needs of individual members.
After patients have attended eight or ten sessions they have usually heard
discussed the role of emotion in the production of disturbance of bodily
function. They have become acquainted with some of the workings of the
unconscious mind; repression, sublimation, projection, ambivalence and
similar mechanisms begin to take on meaning. The importance of infantile
and early child life on the personality formation can be fully accepted, and
with an objective attitude they can discuss the shortcomings and trauma-
tizing activities of their parents. Sibling rivalry is regarded objectively and
they begin to speak of their ambivalence with meaning. We believe that
patients acquire intellectual and emotional insight more rapidly in the
group than in individual sessions. They accept their unconscious motiva-
tions more readily and adjust more satisfactorily. Families can be helped
to understand their structure more easily without activation of resentment.
The sessions afford an impersonal but effective method of aiding in the solu-
tion of emotional problems involving a family or other group.
Our experience with psychoneurotics discharged from the military ser-
vices is worthy of mention. Despite the fact they were found inadequate in
71
310 GROUP PSYCHOTHERAPY
military setting these men have learned to act in groups, and from their .
service they have acquired some feeling of security. As may be expected, they
fit into the group reasonably well. During their military life they had a con-
sciousness of their importance; on return to civilian life many are depressed
because of the unimportance of the role they play in the community. The
group helps in the transition. Despite their ready acceptance of the group
they do not respond as quickly as civilian neurotics because recovery may
mean the loss of their meagre pension. The feeling of guilt which they have
experienced as a result of their separation from the service is an almost
constant characteristic of these veterans but this feeling disappears in the
group. Once such patients have improved to the point of re-employment
their progress is accelerated and seems to be retarded only by the regular
re-examination at the Veterans' Bureau, which they usually regard, as a
threat to the security which their pensions afford. I believe that with sound
psychiatric direction within the Veterans' Bureau and an appreciation by
the veterans' own organizations that they will serve the individual veteran
better when they place the emphasis on aiding him to a complete medical
recovery rather than on increasing his compensation benefits the rehabili-
tation of these men will be made easier. Health, not "hand outs," is the
thing to which our veterans are entitled.
By further use of the group we feel that a greater number of neurotics
can be restored to effective living, not only because greater numbers can
be reached but because many resistant to individual therapy will respond
to group methods. The choice of method rests with the individual, but
when we use the group we are using potent medicine whose properties
must be understood. Marsh has appropriately pointed out that the neurotic
is broken by the group and can be healed by the group.
72
VISUAL AIDS IN GROUP PSYCHOTHERAPY: PUPPETRY 1
LIEUTENANT COLONEL R. ROBERT COHEN, M.C.
Army Service Forces Training Center (Ordnance), Aberdeen Proving
Ground, Maryland
My work with group- psychotherapy in the Army has dealt largely with
preventive psychiatry, and only more recently with the retraining phase. At
Aberdeen Proving Ground, Maryland, I have spoken to many thousands of
trainees in groups varying from 50 to 1000. Talks to them were always of the
repressive-inspirational type as differentiated from the analytical. Very
quickly it was found experimentally that group talks on preventive psychiatry
improved morale, cut down maladjustments, and increased efficiency of train-
ing in new trainees. But also it very quickly became apparent that a means
would have to be devised to make this intangible subject matter concrete and
meaningful this in addition to simple, non-technical language. The answer,
of course, was the visual aid, which to me soon came to be synonymous with
the best and only successful method of presentation in group psychotherapy.
Visual aids are effective because they are dynamic and help focus the
listener's attention on the subject. They cause facts to be remembered 55%
longer. They provide a background where none exists. But, it must be
remembered, the aid must be simple. If necessary to get a point across,
then exact anatomical and psychiatric principles may have to be altered.
Physiological facts frequently may have to be interpreted freely. In general,
"poetic license" may have to be taken in order to get a simple, intep&ting
picture that will serve as a concrete background experience for listeners
who have the varied background, mentalities, and educational achievements
found in a lay group such as is represented by a cross-section soldier audi-
ence. Thus, to illustrate a talk to new trainees on homesickness and regi-
mentation, simple charts without regard for anatomy were presented to show
a "brain" consisting of emotions, a "body control section," and a "think
box." To illustrate a talk on fear, use was made of symbolic figures. Emo-
tions were represented by primitive animals under control; body control was
represented by an overalled mechanic at a switchboard; and reason was rep-
resented by a familiar chap in the driver's seat.
1 Grateful acknowledgment is hereby being made to the Editor of "Occupational
Therapy and Rehabilitation" for December 1944, in which the first four paragraphs
of this paper appeared originally.
73
311
312 GROUP PSYCHOTHERAPY
_ * i __
Furthermore, in order to reinforce the effect of the message from psy-
chiatry, use was made of a picture-story form of booklet. The points we
wished to put over from the talks were put into a cartoon booklet, A Story
of Mack and Mike, depicting the life of two average new trainees. They
are shown going through adjustment to Army life; the right and the wrong
ways to meet military training are brought out,
The previously described group psychotherapy visual aids, however, all
dealt with static presentation. Perhaps the best type of visual aid, therefore,
is puppetry which was employed recently in retraining psychoneurotics,
both of the domestic and battle variety. This method has all the concrete-
ness of the other aids, but, in addition, has the added advantages of humor
and movement. Puppets are admirably suited to presenting a basic under-
standing of human emotions to the average soldier, because a puppet as a
symbolic character can easily project an abstract idea which a human actor
would find difficult and involved. In effect, the puppet is a three-dimensional
presentation of an otherwise completely abstract concept. In using puppets
with Army men in an understanding of psychoneurosis, puppets make real
such emotions as resentment, fear, anger, and sorrow; that is, they present
convincingly the fact that these abstractions really exist. Thus, when a
soldier has a painful foot he knows it is due to a blister because he can
see the blister. In a like manner, when he is told that his bodily reverbera-
tions are due to emotion, he can now believe the relationship because he can
see concretely that emotion at work. Furthermore, puppets are valuable
because they can change their attitudes quickly. These small characters
can change over from extreme euphoria and happiness to marked depression
and sadness in considerably less time than it would take a human actor
to make the transition. Therefore, the puppet can say things more convinc-
ingly within the limits of a short play; and what's more, can say things
which no person could say and get away with.
In presenting the story of battle fatigue to soldiers, the relationship
between emotions and exhaustion and physical symptoms is shown by de-
picting a soldier puppet, GI Joe, in a combat situation. For many days he
has been pinned down in his foxhole, exhausted from lack of rest and sleep,
constant shelling, canned food, threat of body injury and death. When his
breaking point is passed from sheer exhaustion, normal control over emo-
tions breaks down; and when to Common Sense, a capped and robed pro-
74
GROUP PSYCHOTHERAPY 3 13
fessorial puppet, he replies, "I'm tired out and don't give a damn!", then
his emotions rapidly begin to gang up on him.
Rufus Resentment, a primitive loin-girded puppet, moves in on him
first. Explaining that "when the soldier is so tired he can't hang on and keep
control of his body," Rufus Resentment swings a dub and bangs GI Joe
over the head with it. "Ill make his body hurt and shake so he won't even
recognize it!" Immediately, GI Joe reacts with resentment: "What a hole!
Why did I have to get stuck here? Where the hell is the rest of the Army?"
When next Freddie Fear, a tremulous terrified puppet, whimpers, "Did you
know that 20 panzer divisions were coming this way? Say, you ought to be
scared!", panic is registered. Then Archibald Anger, a red-faced scowling
puppet next slams GI Joe's head and roars, "I don't see why you stand for
all this stuff. Let them know you're no dope. Get so mad you don't know
what you're doing!" Sam Sorrow, a sad mournful puppet, finishes the job
with "Say, boy, it's a tough life you have here. It's a shame you had to
give up your civilian life for all this. Constant bombings, canned food, and
no sleep; it's enough to get any man down. Why don't you consider your-
self for awhile? Get feeling sorry for yourself." And as the scene ends, the
effects of the emotional onslaught are summarized by Rufus Resentment,
the ringleader, in "now we're the rulers of this man, Resentment, Fear,
Anger, and Sorrow. We can twist and turn his mind. We've got him so
mixed up, he won't be himself not up here anyway. He's too tired to know
that his loss of appetite, belly pains, shakiness, heart pains, and blackout
are caused by us. He thinks he's sick from disease. Hell blame everybody
but us pretty soon. If we can just keep him from getting back his con-
trol; if he just won't have anything to do with that guy, Common Sense,
well keep him jumping through hoops!"
The concluding site is placed in an automotive shop. GI Joe, after the
rest and food of a hospitalization, has been returned to duty for retraining.
Now he listens intently as Common Sense tells him how to overcome his
psychosomatic complaints with "guts," a sense of humor, and interest in a
job. That the method works is amply shown, for the fortified GI Joe can
now withstand and control his troublesome emotions. In turn, he takes care
of Anger, Sorrow, and Resentment. To Archibald Anger's, "What are you
knocking yourself out for? You've got plenty to gripe about. Let the other
fellows do the job," he replies as he knocks Archie off the stage, "This war
isn't over with yet, see! I've got a job to do and if those gays, think they
75
314 GROUP PSYCHOTHERAPY
can give me trouble, they're way off the beam. This stuff Pm learning will
not only help get this war over with, but will probably be of use to me in
civilian life." To Sam Sorrow's "Civilian life's where you ought to be right
now. Plenty of girls back home, you know," he replies with, "Quit now
with all my buddies still fighting? What do you think I am?" as he throttles
Sam off the stage. Finally, to Rufus Resentment's "Say, me pals tell me
you don't listen to a thing they say. I thought you were on our side," he
bats Rufus off the stage and doses with, "I'm on a side, you bet. On the side
all my buddies are on for victory and a free life. I'm on the side of
getting this truck repaired so fast, it will knock out every last Fascist
on earth. Buddies, there are millions on our side!"
76
SCIENTIFIC FOUNDATIONS OF GROUP PSYCHOTHERAPY
J. L. MORENO
Psychodramatic Institute, New York City
The late arrival of group psychiatry and group psychotherapy has a
plausible explanation when we consider the development of modern psychia-
try out of somatic medicine. The premise of scientific medicine has been
since its origin that the locus of physical ailment is an individual organism.
Therefore treatment is applied to the locus of the ailment as designated by
diagnosis. The physical disease with which an individual A is afflicted
does not require the collateral treatment of A's wife, his children and
friends. If A suffers from an appendicitis and an appendectomy is indi-
cated, the appendix only of A is removed, no one thinks of the removal of
the appendix of 4's wife and children too. When in budding psychiatry
scientific methods began to be used, axioms gained from physical diagnosis
and treatment were automatically applied to mental disorders as well.
Extra-individual influence as animal magnetism and hypnotism was pushed
aside as mythical superstition and folklore. In psychoanalysis at the be-
ginning of this century the most advanced development of psychological
psychiatry the idea of a specific individual organism as the locus of
psychic ailment attained its most triumphant confirmation. The "group"
was implicitly considered by Freud as an epi-phenomenon of the individual
psyche. The implication was that if one hundred individuals of both sexes
were psychoanalyzed, each by a different analyst with satisfactory results,
and were to be put together into a group, a smooth social organization
would result; the sexual, social, economic, political and cultural relations
evolving would offer no unsurmountable obstacle to them. The premise pre-
vailed that there is no locus of ailment beyond the individual, that there is,
for instance, no group situation which requires special diagnosis and treat-
ment. The alternative, fiowever, is that one hundred cured psychoanalysands
might produce a societal bedlam together.
Although, during the first quarter of our century, there was occasional
disapproval of this exclusive, individualistic point of view, it was more silent
than vocal, coming from anthropologists and sociologists particularly. But
they had nothing to offer in contrast with the specific and tangible demon-
strations of psychoanalysis, except large generalities like culture, class and
77
316 GROUP PSYCHOTHERAPY
societal hierarchy. The decisive turn came with the development of sociom-
etric and psychodramatic methodology.*
The change in locus of therapy which the latter initiated means literally
a revolution in what was always considered appropriate medical practice,
Husband and wife, mother and child, are treated as a combine, often facing
one another and not separate (because separate from one another they may not
have any tangible mental ailment). But that facing one another deprives
them of that elusive thing which is commonly called "privacy." What remains
"private" between husband and wife, mother and daughter, is the abode
where some of the trouble between them may blossom, secrets, deceit, sus-
picion and delusion. Therefore the loss of personal privacy means loss
of face and that is why people, intimately bound up in a situation fear to
see one another in the light of face to face analysis. (They prefer individual
treatment.) It is obvious that once privacy is lifted (as a postulate of in-
dividual psyche) for one person involved in the situation, it is a matter of
degree for how many persons the curtain should go up. In a psychodramatic
session therefore, Mr. A, the husband, may permit that besides his wife,
his partner in the sickness, the other man (her lover) is present, later his
daughter and son, and some day perhaps, they would not object (in fact
they would invite it), that other husbands and wives who have a similar
problem, sit in the audience and look on as their predicaments are enacted
and learn from the latter how to treat or prevent their own. It is dear
that the Hippocratic oath will have to be reformulated to protect a group
of subjects involved in the same therapeutic situation. The stigma coming
from unpleasant ailment and treatment is far harder to control if a group
of persons are treated than if it were only one person.
But the change of locus of therapy has other unpleasant consequences,
It revolutionizes also the agent of therapy. The agent of therapy has usually
been a single person, a doctor, a healer. Faith in him, rapport (Mesmer),
transference (Freud) towards him, is usually considered as indispensable
to the patient-physician relation. But sociometric methods have radically
changed this situation. In a particular group a subject may be used as an
instrument to diagnose and as a therapeutic agent to treat the other subjects.
The doctor and healer as the final source of mental therapeusis has fallen.
*Sociatry is applied sociometry. The group psychotherapies are subfields of sociatry,
as the latter comprises also the application of sociometric knowledge to groups "at a
distance", to inter-group relations and to mankind as a total unit.
78
GROUP PSYCHOTHERAPY 317
Sodometric methods have demonstrated that therapeutic values (tele) are
scattered throughout the membership of the group, one patient can treat
the other. The role of the healer has changed from the owner and actor of
therapy to its assigner and trustee.
But as long as the agent of psychotherapy was a particular, special
individual, a doctor or a priest, besides being considered the source or the
catalyzer of healing power because of his personal magnetism, his skill as
a hypnotist or as a psychoanalyst the consequence was that he himself
was also the medium of therapy, the stimulus from which all psychothera-
peutic effect emanated, or at least, by which they were stimulated. It was
always his actions, the elegance of his logic, the brilliancy of his lecture,
the depth of his emotions, the power of his hypnosis, the lucidity of his
analytic 'interpretation, in other words, he, the psychiatrist was always the
medium to which the subject responded and who in the last analysis, deter-
mined the mental status which the patient had attained. It was, therefore,
quite a revolutionary change, after disrobing the therapist of his unique-
ness, showing for instance that in a group of 100 individuals every indi-
vidual participant can be made a therapeutic agent of one or the other in
the group and even to the therapist himself, to go one step further and to
disrobe all the group therapeutic agents themselves of being the media
through which the therapeutic effects are attained. My means of a produc-
tion on the stage a third element is introduced besides the healer and the
patient-members of the group; it becomes the medium through which
therapeutic measures are channelized. (This is the point where I went with
psychodramatic methods beyond the methods I had used previously in
group psychotherapy, even in its most systematic form the group psycho-
therapies based on sociometric procedures and sociometric analysis.) In psy-
chodramatic methods the medium is to a degree separated from the agent.
The medium may be as simple and amorphous as a still or moving light, a
single sound repeated, or more complex, a puppet or a doll, a still or a
motion picture, a dance or music production, finally reaching out to the
most elaborated forms of psychodrama by means of a staff consisting of
a director and auxiliary egos, calling to their command all the arts and
all the means of production. The staff of egos on the stage are usually not
patients themselves, but only the medium through which the treatment is
directed. The psychiatrist as well as the audience of patients are often left
outside of the medium. When the locus of therapy changed from the individual
79
318 GROUP PSYCHOTHERAPY
to the group, the group became the new subject (first step). When the group
was broken up into its individual little therapists and they became the
agents of therapy, the chief therapist became a part of the group (second
step) and finally, the medium of therapy was separated from the healer
as well as the group therapeutic agents (third step). Due to the transition
from individual psychotherapy to group psychotherapy, group psycho-
therapy includes individual psychotherapy; due to the transition from group
psychotherapy to psychodrama, psychodrama includes and envelops group
psychotherapy as well as individual psychotherapy.
The three principles, subject, agent* and medium of therapy can be
used as points of reference for constructing a table of polar categories of
group psychotherapies. I have differentiated here eight pairs of categories:
amorphous vs. structured, loco nascendi vs. secondary situations, causal vs.
symptomatic, therapist vs. group centered, spontaneous vs. rehearsed, lec-
tural vs. dramatic, conserved vs. creative, and face to face vs. from a dis-
tance. With these eight sets of pairs, a classification of every type of group
psychofEerapylato be made.
Table I
BASIC CATEGORIES OF GROUP PSYCHOTHERAPY
SUBJECT
Of Therapy
1. As to the Constitution of the Group
Amorphous vs. Structured (organized) Group
Without considering the organization Determining the dynamic organizatioo
of the group in the prescription of of the group and prescribing therapy
therapy. upon diagnosis.
2. As to Locus of Treatment
Treatment of Group in LocoNas- Treatment Deferred to Secon-
cendi, In Situ vs. dary Situations
Situational, for instance within the Derivative, for instance in especially
home itself, the workshop itself, etc. arranged situations, in clinics, etc.
3. As to Aim of Treatment
Causal vs. Symptomatic
Going back to the situations and indi- Treating each individual as a separate
viduals associated with the syndrome unit. Treatment may be deep, in the
and including them in vivo in the treat- psychoanalytic sense, individually, but
ment stmation. it may no t be deep groupally.
80
GROUP PSYCHOTHERAPY 319
AGENT
Of Therapy
1. As to Source or Transfer of Influence
Therapist Centered vs. Group Centered Methods
Either chief therapist alone or chief Every member of the group is a thera-
therapist aided by a few auxiliary peutic agent to one or another mem-
therapists. Therapist treating every ber, one patient helping the other. The
member of the group individually or group is treated as an interactional
together, but the patients themselves whole,
are not used systematically to help one
another.
2. As to Form of Influence
Spontaneous and Free vs. Rehearsed and Prepared Form
Freedom of experience and expression. Suppressed experience and expression.
Therapist or speaker (from inside the Therapist memorizes lecture or re-
group) is extemporaneous, the audi- hearses production. The audience is
ence unrestrained. prepared and governed by fixed rules.
MEDIUM
Of Therapy
1. As to Mode of Influence
Lecture or Verbal vs. Dramatic or Action Methods
Lectures, interviews, discussion, read- Dance, music, drama, motion pictures*
ing, reciting.
2. As to Type of Medium
Conserved, Mechanical or Un-
spontaneous vs. Creative Media
Motion pictures, rehearsed doll drama, Therapeutic motion pictures as pre-
rehearsed dance step, conserved music, paratory steps for an actual group
rehearsed drama. session, extemporaneous doll drama
with the aid of auxiliary egos behind
each doll, psychomusic, psychodrama
and sododrama.
3. As to Origin of Medium
Face to Face vs. From-a-Distance Presentations
Any drama, lecture, discussion, etc Radio and television.
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320 GROUP PSYCHOTHERAPY
VALIDITY OF GROUP METHODS
All group methods have in common the need for a frame of reference
which would declare their findings and applications either valid or invalid,
One of my first efforts was therefore, to construct instruments by means of
which the structural constitution of groups could be determined. An instru-
ment of this type was the sociometric test and it was so constructed that it
could easily become a model and a guide for the development of similar
instruments. My idea was also that if an instrument is good, its findings
and discoveries would be corroborated by any other instrument which has
the same aim, that is, to study the structure resulting from the interaction
of individuals in groups. After social groups of all types had been studied,
formal and informal groups, home groups and work groups, and so forth,
the question of the validity of group structure was tested by using first
deviations from chance as a reference base, second by control studies of
grouping and regrouping of individuals.
Deviation from chance experiments. A population of 26 was taken as
a convenient unit to use in comparison with a chance distribution of a
group of 26 fictitious individuals, and three choices were made by each mem-
ber. For our analysis any size <jl population, large or small, would have
been satisfactory, but use of 26 'persons happened to permit an unselected
sampling of groups already tested. Without including the same group, more
than once, seven groups of 26 individuals were selected from among those
which happened to have this size population. The test choices had been
taken on the criterion of table-partners, and none of the choices could go
outside the group, thus making comparison possible; Study of the findings
of group configurations (resulting from the interacting individuals) in
order to be compared with one another, were in need of some common ref-
erence base from which to measure the deviations. It appeared that the most
logical ground for establishing such reference could be secured by ascer-
taining the characteristics of typical configurations produced by chance
balloting for a similar size population with a like number of choices. It
became possible to chart the respective sociograms (graphs of interactional
relations) of each experiment, so that each fictitious person was seen in
respect to all other fictitious persons in the same group; it was also possible
to show the range in types of structures within each chance configuration
of a group. The first questions to be answered read: What is the probable
number of individuals who by mere chance selection would be picked out by
82
GROUP PSYCHOTHERAPY 321
their fellows, not at all, once, twice, three times, and so on. How many pairs
are likely to occur, a pair being two individuals who choose one another.
How many unreciprocated choices can be expected on a mere chance basis?
The experimental chance findings followed closely the theoretical chance
probabilities. The average number of pairs in the chance experiment was
4.3, in the theoretical analysis 4.68 (under the same condition of 3
choices within a population of 26 persons). The number of unreciprocated
choices was in the chance experiments 69.4, the theoretical results showed
68.64 under the same conditions.
Among the many important findings the most instructive to the group
psychotherapists were: a) a comparison of the chance sociograms to the
actual sociograms shows that the probability of mutual structures is 213 per
cent greater in the actual configurations than in chance, and the number
of unreciprocated structures is 35. 8 per cent rarer actually than by chance;
the more complex structures such as triangles, squares and other closed
patterns of which there were seven in the actual sociograms were lacking"
in the chance sociograms; b) a greater concentration of many choices upon
few individuals, and a weak concentration of few choices upon the majority
of individuals, skewed the distribution of the sampling of actual individuals
still further than took place in the chance experiments, and in a direction
it need not necessarily take by chance. This feature of the distribution is
called the sododywmc effect. The actual frequency distribution compared
with the chance distribution showed the quantity of isolates to be 250 per
cent greater in the former. The quantity of overchosen individuals was
39 per cent greater while the volume of their choices was 73 per cent greater.
Such statistical findings suggest that if the size of the population increases
and the number of choice relations remain constant, the gap between the
chance frequency distribution and the actual distribution would increase
progressively. The sociodynamic effect has general validity. It is found in
all social groupings whatever their kind, whether the criterion is search for
mates, search for employment or in socio-cultural relations. The frequency
distribution of choices shown by sociometric data is comparable to the fre-
quency distribution of wealth in a capitalistic society. In this case also the
extremes of distribution are accentuated. The exceedingly wealthy are few,
the exceedingly poor are many. Economic and sociometric curves are both
expressions of the same law, a law of sociodynamics.
Control studies. Two groups of individuals were compared. In the
one, Group A, the placement to the cottage was made hit or miss, in the
83
322 GROUP PSYCHOTHERAPY
second, Group B, the placements were made on the basis of the feelings
which the incoming individuals had for the cottage parent and for the other
inhabitants of the cottage, and vice versa. Sociometric tests were then ap-
plied at intervals of 8 weeks so that we could compare the structure of the
control group A with the tested group B. Among other things it was found
that the tested individuals undergo a quicker social evolution and integra-
tion into the group than the individuals who have been placed in a cottage
hit or miss. At the end of a thirty-two weeks period the control group
showed four times as many isolated individuals as the tested group. The
tested group B showed twice as many individuals forming pairs than the
control group.
Indications and contra-mdications of group psychotherapy. The indi-
cation of group psychotherapy or of one particular method in preference to
another must be based on the sociodynamic changes of structure which can
be determined by means of group tests of which two illustrations have been
given above. Group psychotherapy has come of age and promises a vigor-
ous development largely because group theory and group diagnosis have
paved the way and have kept pace with the rapidly expanding needs for
application.
BIBLIOGRAPHY
Urie Bronfenbrenner, "The Measurement of Sociometric Status, Structure
and Development," Sociometry Monographs, No. 1, Beacon House,
New York, 1945.
Helen H. Jennings, "Control Study of Sociometric Assignment," Sociometric
Review, 1936.
J. L. Moreno aad Helen H. Jennings, "Sociometric Measurement of Sodal
Configurations, Based on Deviation from Chance," Sociometry, Vol-
ume 1, part II, 1938 and Sociometry Monographs, No. 3, Beacon
House, New York.
Howard P. Rome, "Therapeutic Films and Group Psychotherapy," Sod-
ometry, Volume 8, No. 3-4, 194S.
Gregory Zilboorg and George W. Henry, "A History of Medical Psycholo-
gy," W. W. Norton & Company, New York, 1941,
84
LECTURE METHODS
THE GROUP METHOD IN THE TREATMENT OF
PSYCHOSOMATIC DISORDERS
JOSEPH H. PRATT, M.D., Sc.D.
In 1913, Dr. Smith Ely Jelliffe of New York translated and edited a
book entitled "The Psychoneuroses and Their Treatment by Psychotherapy."
It was the work of the distinguished French neurologist, J. Dejerine (1)
and his pupil E. Gauckler. For some reason, this very important book was
not widely read and reference has rarely been made to it by American or
English writers on the psychoneuroses. An exception was the English
psychiatrist, T. A. Ross, who in the preface of "The Common Neuroses" (2),
published in 1923, stated that Dejerine is the writer to whom he owes most.
He adds that Dejerine was not lucky in the time of publishing his psycho-
logical books as "English Psychotherapists were under the spell of Freud,"
whose conceptions were "so much more brilliant and fascinating than
Dejerine's who lived in a plain work-a-day world, that this not need sur-
prise anyone. "Now, however," Ross went on to say, "Freud's views are
less potent therapeutically than it was at one time hoped they would be.
The time has perhaps come when the more sober and less dazzling idea may
receive some of the attention which it failed to attract ten years ago." This
hope was only partially realized, as Ross's book like Dejerine's earlier work
did not make the impression on the medical profession of this country that
it deserved.
At the outset of his career, Dejerine used Weir Mitchell's methods
which were based on purely physical measures but it was not long before
he made the important discovery that "unless the patient's state of mind
improved, the therapeutic results were far from satisfactory." He thus came
to realize that in order to cure patients suffering from functional nervous
disorders, "the first and most important thing was to get hold of their
morale, in other words, to practise psychotherapy." This he had been doing
for a quarter of a century before he wrote his book with a success that
indicates the soundness of his views. He recognized that the cause of this
success was the moral treatment he employed. Unless moral and spiritual
re-education leads to effective action, there is no persuasion. To effect a
cure a change -must be wrought in the personality of the patient, and this
is only brought about when the patient has acquired absolute confidence
85
324 GROUP PSYCHOTHERAPY
in his physician. There must be an emotional appeal that makes the new
ideas "acceptable to consciousness and this brings about conviction."
Dejerine was one of the first to realize that psychosomatic disorders
are due to emotional maladjustments and that cure results by removing the
emotional cause, and replacing bad emotional habits with good ones. As he
treated the emotional cause and not the varied physical symptoms the
patients presented, unlike most neurologists and psychiatrists in this coun-
try, he did not limit his practice to patients presenting nervous and psychic
manifestations but included all cases of emotional origin that were brought
to him. He recognized a truth known to Sydenham three hundred years
ago but unknown, unfortunately, to most physicians today that pain local-
ized in* any part of the body may be due to hysteria or hypochondriasis, in
other words to an emotional cause.
Knowing that the seat of the disorders was in the personality of the
patient, Dejerine treated with success scores of cases with digestive disturb-
ances, cardiovascular, respiratory, and genito-urinary symptoms as well as
other conditions in which the somatic features seemed on superficial study
to form the entire clinical picture. Painstaking inquiry, however, brought
to light the underlying emotional disturbance which was the cause of the
illness.
As Ross points out, Dejerine's treatment is a form of faith cure; faith
in the psychotherapist or, as I hope to show later, faith in a group or class
and its teachings. Dejerine realized this and in one place quotes the old
adage "It is faith that saves ... or cures."
It was about thirty years ago that Dejerine's book came into my hands.
From it, I learned a method that I was able to employ with success in
the treatment of the neuroses. Up to that time, I had relied chiefly on
physical methods, such as rest, exercise, baths, and congenial work. After
a thorough physical examination supplemented by laboratory tests, I would
tell the patient that he had no organic disease. This reassurance, as Dejerine
points out, was about the limit of the psychotherapy practised by most
physicians and needless to say, it was rarely effective in removing the
patient's symptoms.
I recall vividly the first patient that I treated by Dejerine's methods
and the diligence with which I attempted by study of his book to carry
out the treatment exactly as he advised.
The patient was brought to Boston from her home in North Carolina
to consult me. She came reluctantly at the insistence of her husband who
LECTURE METHODS 325
accompanied her. She told me in the first interview, and I detected a
note of pride in her voice, that she had consulted twenty-four physicians
and none had given her the least help, I determined then that if possible,
with Dejerne's help, that I would not be the twenty-fifth in an endless
series. She had severe indigestion accompanied by occasional attacks of
intense abdominal pain that alarmed nurses and physicians. Every doctor
she consulted had prescribed a diet but none of these had lessened her
distress. Her weight had dropped to less than one hundred pounds. Her
complaints were all referred to her abdomen and her mental state had
never been investigated. Several interviews of an hour each, as Dejerine
advised, were employed in taking the history. I let her talk without inter-
ruption until she had told all she wished to tell. Then I drew out informa-
tion regarding her emotional life although in her mind it had no bearing
on her illness. At last I knew the events of her life in some detail and
also her attitude of mind. Then I sought to trace a relationship between
her attacks of intestinal colic and her emotional state at the time they
occurred. The last seizure had taken place several months before I saw
her and had been unusually severe. It was due she said to eating a cucum-
ber salad. "Wasn't that at about the time of your mother's death?" I in-
quired. "Yes, a few days before the end," she replied. I learned that she
was so prostrated by her mother's 'illness that she had to take to her bed
and could not even visit her mother before she died. "Did you see no
relation between your mental agitation and the attack of severe colic?"
"No," she said, "I was sure it was the cucumber salad that caused it." I
had little difficulty in persuading her to accept Dejerine's teachings. Soon
she was eating everything without distress and gained weight rapidly.
Since then I have employed this common sense psychotherapy over the
years and have demonstrated repeatedly that functional nervous disorders
are the result of abnormal emotional reactions and are cured by treating
the patient's personality.
Individual treatment is costly in time to the physician and costly in
money to the patient. It cannot be employed in large out-patient clinics
for two reasons. (1) The patients are too numerous. (2) Those who can
employ psychotherapy successfully are too few.
In the large medical clinic of the Boston Dispensary, I taught my
assistants to recognize the functional nervous cases. Correct diagnoses
greatly increased the number of cases that were recognized to be functional
nervous disorders. An analysis of 500 cases admitted to the Medical Clinic
87
326 GROUP PSYCHOTHERAPY
revealed the fact that over thirty per cent belonged in this category. These
came to the Clinic complaining of somatic symptoms. Those with frank
nervous symptoms were not included as they were referred directly to the
Nerve Clinic by the admitting office. Many of the cases which we found
to be personality disorders had previously been regarded as examples of
organic diseases. Hyperacidity, chronic rheumatism, neuritis and neuralgia,
chronic appendicitis, back strain and sacro-iliac disease, and the menopausal
syndrome were among the frequent false diagnoses which we had to correct.
Although the right diagnosis was made, treatment by persuasion and moral
education seemed impossible. The treatment we did employ with indi-
vidual patients was as ineffective as in other clinics and as a result the
patients often made visit after visit over months and years complaining of
the same symptoms.
As I had employed the group or class method years before in the treat-
ment of pulmonary tuberculosis (3), it occurred to me that this method
might be useful in meeting the pressing problem presented by our emotion-
ally maladjusted patients. At least I would have the opportunity of giving
them some information in regard to the effects of emotional reactions on
the body and some instruction in mental hygiene.
The first meeting of the group was on the morning of April 11, 1930.
Since then meetings have been held once a week except during a summer
recess. At the start I had the able assistance of Miss Edith Canterbury of
the Social Service Department. At the outset, I had no idea how to proceed
as I had no precedent. I felt like a mariner traveling uncharted waters.
Three women patients from the Medical Clinic were present at that first
meeting and the testimony of one of them of her recent relief from pain
gave us a successful start. A few days earlier I had interviewed this patient,
Mrs. C., in the Medical Clinic. I had already at that time gained her con-
fidence as some months previously she had come to me complaining of
pain in the shoulder and had speedily recovered. This time her condition
was much more serious. For three months she had had a pain in the back
so severe as to confine her to bed. Finally she had managed to make the
trip to the office of a prominent gynecologist. He found some minor pelvic
abnormality and to this attributed her disabling backache. He recommended
an operation, and as she was a poor woman, had referred her to my clinic
at the Boston Dispensary to determine whether her general condition would
permit of his undertaking the operation without delay.
Although she complained only of the back ache, after listening to her
88
LECTURE METHODS 327
story, I said, "What is the real trouble? Tell me the whole story." Without
hesitation she replied that it had been fear her husband would lose his job.
This had tormented her for months. He looked so tired and wan at night
on returning home from work that she was filled with forebodings. It was
very difficult to pay the bills with his meagre wages, and what would happen
to the children if he became sick and could not work? This state of mental
agitation had persisted for some time when the back ache developed. Her
relief of mind was very great when I assured her no operation was needed
and that her back ache would disappear when she banished her fears and
gained mental serenity* She accepted my statement at once without the
least questioning doubt.
At the first class meeting, she instilled hope into the minds of the
other two patients by telling the story of her dramatic recovery. When
she had come to the Dispensary to ascertain whether her condition would
warrant the operation, she was so weak that she had to steady herself by
keeping her right hand on the brick walls of the buildings as she walked
down narrow Bennet Street to the Dispensary. When she left she felt as
if she were walking on air. She kept repeating to herself, "No operation,
no operation." She stopped at the market on her way home and bought
provisions. That afternoon she washed the kitchen floor and for the first
time in three months prepared her husband's supper. The back ache
was gone.
A few months later with health restored after faithfully following the
instructions ^iven at the class meetings, she told the following incident:
A few days earlier a friend had stopped her on the street and drawing her
to one side said in low tones, "Everyone is talking of your wonderful recov-
ery, Mrs. C., but you tell me the truth for I know it was a miracle. You
visited Father Powers' grave at Maiden and were cured." "No," replied'
Mrs. C. "It wasn't Father Powers' grave, it was Dr. Pratt's thought control
class." That gave us our name. We had been at a loss to find a suitable
name, and here it was supplied by an uneducated member. She had grasped
the central teaching that cure was wrought by thought and emotional con-
trol. A strong vitalizing emotion had removed her pain but the underlying
cause of it had been eradicated by an altered state of mind; in other words
by moral re-education as Dejermine termed it.
As I was the physician-in-chief of the Medical Clinic, I was able to
make a ruling that all patients whose symptoms were found on thorough
examination to be due to a functional nervous disorder were to be referred
89
328 GROUP PSYCHOTHERAPY
to the class without delay. As a result over 2,000 patients have been sent
to us. Two psychologists, Mr, Winfred Rhoades and Dr. Rose Hilferding
are in daily attendance at the Dispensary and they hold a preliminary
interview with all patients before they attend their first meeting. At this
interview a psychological history is added to the medical record. A brief
explanation is given of the effects of the emotions on the body and mind
in an effort to break down the resistance many patients feel to psychological
treatment.
The methods used in conducting the meeting have been little changed
during the fifteen years of its existence. They were described in some detail
in a previous paper (4). The members are seated in the lecture hall accord-
ing to the number of sessions they have attended. The four with the highest
score sit on a settee placed on the platform to the left of the class leader
and facing the other members of the class. This was done at the suggestion
of the late Dr. John G. Gehring, the distinguished psychiatrist who sup-
ported the class idea from its inception. He wanted the patients who had
been members for some time and who had recovered to sit in such a position
that the new comers could see what he termed the radiance in their faces.
The newcomers, that is the candidates for membership, are seated on the
front row facing the director. The roll call is made and the class director
repeats the name and enters it in a book together with the number of
meetings attended by each member beginning with the one with the largest
number. This breaks the ice and it serves as an introduction of each member
to the others of the group. They come in this way to associate the names
and faces of their fellow members. The floor secretary then distributes
slips of paper on which each records his progress or lack of progress since
the previous meeting. These are collected at once and read by the class
director without giving the names signed on the reports. With an average
attendance of 20, about IS will state that they are free from symptoms
and feeling "fine". The other five composed chiefly of new members write
that they are no better or only a little improved. Those in the latter group
are asked to remain after the class in order that they may be given appoint-
ments for personal consultations with our psychologist or with our psychia-
trist, Dr. Alfred Hauptmann. All patients who fail to gain after a few
treatments are studied by Dr, Hauptmann and when found to be suffering
from psychoses as occasionally happens are advised regarding other treat-
ment more suitable for them.
Then a relaxation exercise is given. The form I employ is really mild
90
LECTURE METHODS 329
hypnotic suggestion combined with relaxation. For this technique I am
indebted to Professor Elton Mayo. This entire procedure lasts only five
to seven minutes. As a result, nearly all feel relaxed in muscles and mind,
as is indicated by raising their hands. As their eyes are closed at the time,
they do not know the result, but I always announce how many failed to
relax and they are usually only the newcomers. A few may fall asleep and
most of the group claim they feel drowsy. This exercise seems to prepare
them well for the short address that follows. These talks aim to be inspira-
tional. Dr. Giles W. Thomas (5) characterized our entire method of treat-
ment as repressive-inspirational in contrast to the psychoanalytical and the
intellectual methods. I made it a rule not to prepare in advance my little
speech. There is much repetition but this is well received by my hearers
as many attend the meetings for months or even years after their recovery.
I appeal to their hearts rather than their heads; in other words, to their
emotions more than to their reason. Dejerine emphasized the truth that
action is due to an emotional drive and without action, there is no cure.
"You can't change the world, so change yourself," is a favorite quotation
that the members recite with conviction. Following the talk by the class
director, the final ten or fifteen minutes of the hour and a half session are
devoted to testimonies from two or three of the members who speak of
the progress they have made and the lessons they have learned from their
experience.
Patients in the class have usually recovered more quickly than have
my private patients. This I attribute to hope of recovery awakened by
being in the presence of those who were sick and now are well, and secondly
to faith in the class and its methods as well as in the directing physician.
Other classes have been formed in our clinic and conducted with equal
success. Winfred Rhoades, our psychologist has had an evening class for
nearly ten years, established primarily for men who were employed during
the day but is now attended by both men and women. He published an
excellent account of the group method (6). His book "The Self You Have
to Live With" (7) is made up in part of material used in the short addresses
prepared for his class and contains also many experiences of class members
who had learned to adjust themselves to the conditions of life. This book
has proved so helpful that it has been reprinted twelve times. Dr. Herbert
I. Harris (8) organized and conducted an afternoon class. His report on
the group method is excellent. Dr. Alfred Hauptmann (9), a psychiatrist
with large experience in leading German clinics, after a thorough study of
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330 GROUP PSYCHOTHERAPY
our results, published a paper in which he emphasized certain advantages
of the group method over individual treatment. He pointed out that it
should prove of special value in dealing with the war neuroses among the
soldiers. For this reason, the paper was sent for publication to "War Medi-
cine," but the editor returned it evidently regarding the subject of group
treatment not sufficiently important to deserve publication. Yet within
two years, General Marshall issued a general order that group therapy
should be employed by the psychiatrists of the Army.
So far as I know the first class to be formed along lines similar to
burs was that of Dr. Samuel B. Hadden (10) in the outpatient department
of the Presbyterian Hospital of Philadelphia early in 1939. A later paper
(1) reported the success he had obtained, as a statistical analysis of the
results of the first three years of the group therapy showed that of those
who responded to the questionnaire, 90 per cent reported they were bene-
fited; 18 per cent as cured, and SO per cent as much improved.
Anyone who has developed a successful psychotherapeutic method of
treating individual patients can conduct a class with success but on the
other hand if he has not achieved an effective technique with individual
patients, I doubt if he will succeed with a group.
REFERENCES
1. Dejerine, J. and Gauckler, E. The Psyckoneuroses and Their Treat-
ment by Psychotherapy. Philadelphia and London. J, B. Lippincott
Company, 1913.
2. Ross, T. A. The Common Neuroses and Their Treament by Psycho-
therapy. London, Edward Arnold & Company, 1924.
3. Pratt, J. H. The Class Method in the Home Treatment of Tubercu-
losis, and What It Has Accomplished. Boston Medical and Surgical
journal 166:280 (February 22) 1906.
4. Pratt, J. H. The Influence of Emotions in the Causation and Cure
of Psychoneuroses. International Clinics. 4:1, 1934.
5. Thomas, G. W. Group Psychotherapy: A Review of the Recent Litera-
ture. Psychosomatic Medicine. 5; 166 (April) 1943.
6. Rhoades, W. Group Training in Thought Control for Relieving
Nervous Disorders. Ment. Hyg., 19:373, 1935.
7. Rhoades, W. The Self You Have to Live With. Philadelphia. J. B.
Lippincott & Company, 1938.
8. Harris, H. I. Efficient Psychotherapy for the Large Outpatient Clinic.
New England Journal of Medicine. 221:1, 1939.
92
LECTURE METHODS 331
9. Hauptmann, A. Group Therapy for Psychoneuroses. Diseases of the
Nervous System. 4:1 (January) 1943.
10. Hadden, S. B. Treatment of the Neuroses by Class Technic. Annals
of Internal Medicine. 16:33, 1942.
11. Hadden, S. B. Group Psychotherapy: A Superior Method of Treating
Larger Numbers of Neurotic Patients. American Journal of Psy-
chiatry. 101:68 (July) 1944.
93
THE COMBINED SYSTEM OF GROUP PSYCHOTHERAPY AND
SELF-HELP AS PRACTICED BY RECOVERY, INC.
BY ABRAHAM A. Low, M.D.
University of Illinois Medical School, Chicago
Recovery, Inc. was founded in 1937 by thirty patients who recovered
their mental health after receiving shock treatment at the Psychiatric Insti-
tute of the University of Illinois medical school Originally concerned with
after-care for former mental patients exclusively, it now admits to mem-
bership both psychoneurotic and postpsychotic persons. Its main objec-
tive is to reduce the incidence of relapses in mental disease and to combat
chronicity in psychoneurotic conditions.
THE CASE OF THE FORMER MENTAL PATIENT
It was only after Recovery came into being that the author had an
opportunity to acquaint hiifrself with the fate of the discharged mental
patient. In pre-Recovery years, his private patients were seldom seen after
termination of hospital treatment, and his contact with patients discharged
from public institutions was largely limited to the official three parole visits
which added to an already voluminous case record but failed to enlarge
the volume of the physician's knowledge about his patients. In the past
eight years close contact was established with hundreds of discharged mental
patients in private interviews, classes, committee conferences, instruction
courses, social parties and home gatherings. The experience gained in
these multiple contacts demonstrated that the majority of former patients
are the victims of distressing sensations, fears and panics. These "residual
symptoms" call for early after-care if the problem of relapse is to be at-
tacked systematically.
The residual symptom gives rise to anxiety. The popular superstition
of "once mentally ill, always mentally ill" is forcefully endorsed by the
evidence that the patient is "slipping again." Fears and panics are now
fanned into a hysteria that grips patient and family alike.
Recovery insists that the patient, prior to leaving the hospital, attends
group psychotherapy classes in which he is given adequate instruction how
to face the threat of the residual symptom and the pressure of stigmatiza-
tion. At the same time, the members of the family are urged to attend
94
LECTURE METHODS 333
discussion courses in which similar instruction is offered. In this manner,
the pre-discharge care prepares for the after-care effort.
THE CASE OF THE PSYCHONEUROTIC PATIENT
Recovery deals with chronic, protracted cases of psychoneuroses mainly.
Patients with symptoms of a few months' duration are rarities in the
ranks of the group. Most members have a record of from two to twenty
years of suffering. These "experienced sufferers" have made the round of
physicians and clinics and were assured on numerous occasions that some
therapeutic measure will cure them. The assurance never materialized with
the result that they no longer believe a cure possible* They know, however,
that some or most of the past therapies had a transient palliative effect.
The palpitations were milder after a reassuring talk; the dizziness yielded
to a sedative. Hence, they treasure the "pep-talk" or the prescription.
Essentially, they have decided that all they can expect is temporary relief,
not a final cure. The "chronicity" of this group is not based on etiological
or clinical considerations; it is self-appointed defeatism.
THE "RECOVERY" APPROACH TO DEFEATISM
Recovery ignores etiology and classification. Conflicts and complexes,
infantile traumas and subconscious ideologies play little or no part in the
class interviews conducted by the physician and the self-help activities
carried on by the patients. The patient is considered a person who for some
reason has developed disturbing symptom-reactions leading to ill-controlled
behavior. The symptoms are in the nature of threatening sensations, "in-
tolerable" feelings, "uncontrollable" impulses and obsessive "unbearable"
thoughts. The very vocabulary with its frenzied emphasis on the "killing"
headache, the dizziness that "drives me frantic," the fatigue that is "beyond
human endurance" is ominously expressive of defeatism. The first step in
the psychotherapeutic management must be to convince the patient that the
sensation can be endured, the impulse controlled, the obsession checked.
Unfortunately, the physician is far from convincing. His attempt to "sell"
the idea of mental health arouses the "sales resistance" of the patient. "The
physician doesn't dare tell me the truth. It would be against his ethics
to declare me incurable." The resistance is easily overcome in the group
interview. The fellow sufferer who explains how he "licked" his frightful
palpitations after years of invalidism cannot possibly be suspected of trying
95
334 GROUP PSYCHOTHERAPY
to sell something. That "colleague" is convincing. He convinces the novice
that chronic conditions are not hopeless.
THE PATIENTS MEET ON THREE DAYS EVERY WEEK
On three separate days each week the patients take part in group dis-
cussions, either as panel members or listeners. On Wednesdays, a family
gathering is held in a private home. There a panel of three or four experi-
enced members discuss a chapter of the author's three volumes on self-
directed after-care. 1 The theme is centered on the topic of symptoms and
the proper means of conquering them. Thursday evening is devoted to a
group psychotherapy class, conducted by the author. Saturday afternoon,
a public meeting takes place in the Recovery office located in a downtown
building. It is attended by the patients, their relatives and friends. The
first half hour is given over to a panel discussion similar to that held at
the Wednesday home gatherings. In the second half the author delivers an
address in which he sums up the conclusions reached by the panel, approving
or correcting their statements. The panel members are led by the panel
leader.
TREATING THE "SETBACK"
Patients are required to attend classes and meetings for at least six
months. The charges for class attendance are $10.00 a month, the dues
for Recovery membership are $2.00 a year. The average patient experi-
ences a considerable improvement in the first or second week of participation
in the program. But the improvement is, as a rule, as short-lived as was
the relief which the patient used to gain from the visits to clinics and
doctors' offices. No meetings are held between Saturday and Wednesday.
In the intervening four days the novice is apt to suffer a "setback." He is
again tortured by "that awful fatigue" or has been unable "to sleep a wink
for three nights in succession," or the fear of doing harm to the baby
reappears after it was gone for a short while. Every patient is warned to
be on guard against the unavoidable setback. He is cautioned to contact
a veteran Recovery member immediately after the symptom has reappeared.
The assurance offered by the veteran is usually couched in the statement,
"the doctor warned you that you are in for a setback. When I had mine I
*A. A. Low, The Techniques of Self-Help in Psychiatric After-Care, 3 volumes,
Chicago, 1943, published by Recovery, Inc.
LECTURE METHODS 335
knew that sensations are distressing but not dangerous. That helped me.
I waited till the sensation disappeared." Each new member is assigned to a
veteran whom he may call in distress. The veteran functions in the capacity
of the physician's "aide." The contact is generally made by telephone but
may be done by a personal visit to the aide's home. If the result is not satis-
factory the novice is permitted to call on the leader of his local panel. If
this is ineffective he may contact the chairman of the organization who
serves as deputy to the physican. Finally he may call the physician.. The
effectiveness of the scheme is evidenced by the fact that the author remem-
bers few instances only in which he was called by novices.
THE "SYMPTOMATIC IDIOM"
Language, by dint of defeatist implications, engenders tenseness which
reinforces and perpetuates symptoms. To avoid the fatalistic implications
of the language used by the patient the physician must supply a terminology
of his own in matters of health. There are many languages. Features and
gestures speak. So do symptoms. Their language is a one-word idiom:
danger. This is called the "symptomatic idiom." Accepting the implica-
tions of the symptomatic idiom the patient considers the violent palpitations
as presaging sudden death. The pressure in the head is viewed as due to
a brain tumor. The tenseness is so "terrific" that the patient fears he is
going to "burst." His fatigue does not let up "one single minute," and
"how long can the body stand that?" In these instances, the implications
of the symptomatic idiom are those of an impending physical collapse. If
phobias, compulsions and ruminations dominate the symptomatic scene
the resulting fear is that of the mental collapse. After months and years of
sustained suffering the twin fears of physical and mental collapse may
recede, giving way to apprehensions about the impossibility of a final cure.
This is the fear of the permanent handicap. The three basic fears of physical
collapse, mental collapse and permanent handicap are variations of the danger
theme suggested by the symptomatic idiom.
THE "TEMPERAMENTAL LINGO"
Temper is linked to symptoms in a two-way relationship. The symptom
arouses fear or anger, the latter when the patient "gets sore at himself" and
"works himself up." After the temper is aroused it reinforces and intensi-
fies the symptom which again increases the temperamental reaction. In this
336 GROUP PSYCHOTHERAPY
manner, a vicious cycle is established between temper and symptom. After
proper training the patient has no difficulty controlling panicky fears and
angry outbursts. But panics and tantrums are merely the extremes of temper.
In its middle range temper is subtle, elusive and deceitful. It deceives by
means of the "temperamental lingo." By labelling sensations as "intolerable/'
feelings as "terrible," impulses as "uncontrollable" the lingo discourages the
patient from facing, tolerating or controlling the reaction. All a patient has
to do is to call a crying reaction by the name of "crying spell," and no
effort will be made to check the burst of tears, The word "spell" suggests
uncontrolkbility. Make the patient substitute "crying habit" for "crying
spell," and the impossibility of stemming the flood is at least not taken for
granted. Similarly, if the patient raves about the "splitting" headache, the
dizziness that "drives me mad," the pressure that "I can't stand," the
fatalism of diction is bound to breed a despondency of mood. In order to
prevent the temperamental response the patient must be trained to ignore
the whisperings of his temperamental lingo.
THE "RECOVERY LANGUAGE"
The combined effects of symptomatic idiom and temperamental lingo
are checkmated if the patient is made to use the physician's language only.
The members call it proudly the "Recovery language." Its vocabulary is
limited in the main to two words: "sabotage" and "authority." The
authority of the physician is sabotaged if the patient presumes to make a
diagnostic, therapeutic or prognostic statement. The verbiage of the tem-
peramental lingo ("uncontrollable," "unbearable," etc.) constitutes sabotage
because of the assumption that the condition is of a serious nature (diag-
nosis) and difficult to repair (prognosis). It is a crass example of sabotage
if the claim is advanced that "my headache is there the very minute I wake
up. I didn't even have time to think about it. It came before I even had
a chance to become emotional How can that be nervous?" This throws
a serious doubt on the validity of the physician's diagnosis and sabotages
his authority. Likewise, it is a case of self-diagnosing and consequently
sabotage to view palpitations as a sign of heart ailment and pressure as
meaning brain tumor. Once the physician has made the diagnosis of a
psychoneurosis or postpsychotic condition the patient is no longer permitted
to indulge in the pastime of self-diagnosing. If he does he is classed as
saboteur. Patients are required to lose their major symptoms after two
98
LECTURE METHODS 337
months of Recovery membership and class attendance. If after the two
month period the handicap persists in its original intensity the indication
is that sabotage is still in action. The patient still listens to the suggestions
of the symptomatic idiom fearing impending collapse and permanent handi-
cap. Or, he indulges in the verbal vagaries of the temperamental lingo,
feeling helpless in the face of suffering. Clinging to his own mode of think-
ing he sabotages the physician's effort.
Contrary to expectation, it is comforting to the patient to be branded
a saboteur. Considering himself as such he knows that he has "not yet"
learned to avoid resisting the physician. The "not yet" is reassuring. It
suggests that in time he will learn. "Wait till you get well;" "wait till you
will learn to give up sabotaging;" these are most effective therapeutic
slogans handed down from veteran to novice.
GENERAL COMMENT
The description here given of the Recovery system is sketchy and frag-
mentary at best. Even so it may be expected to convey a tolerably correct
bird's eye view of its basic principles. Its main effect is to discipline the
patient, to make him bear, or at least, share the responsibility for his
continued invaJidism, Essentially it tells the patient: The physician gives
you the opportunity to conquer your handicap. If you engage in sabotage
activities the process of getting well will be delayed, and the responsibility
for prolonging your suffering will rest on you. The procedure may savor of
dictatorial harshness but is nothing but firm leadership. That this is so can
be easily gathered from the spirit of cordiality that is characteristic of
the physician-patient relationship within the Recovery framework. This is
not the place nor the time to offer results in terms of percentages of cures.
Suffice it to state that the author has been able, with the aid of Recovery
technique, to improve his therapeutic effectiveness measurably beyond what
he accomplished in the pre-Recovery days of his psychiatric practice.
99
ANALYTICAL GROUP METHODS
GROUP PSYCHOTHERAPY
E. W. LAZEIZ, MD.
Veterans? Administration Facility
Northport, L L, N. F *
The treatment of disease has been rapidly becoming a more exact
science during the past half century. This has been due to clearer concepts
of the position which the individual occupies in Society and his reactions
to the many stimuli which he must resolve.
Before any progress could be made, two great fallacies had to be
broken down and correct concepts substituted for them:
The first fallacy was that Man is merely a physical being. The first
substitution for this fallacy was the acceptance of the concept of Man as
having a physical and a mental phase the body and the mind, a biologic
entity. This dualism, however, was scarcely better than the old idea. It
was only when the monism, the body/mind, was accepted that real progress
was made.
There is a great difference between the two ideas. The concept of a
body and a mind means that there are two entities, perhaps independent
of each other. It was difficult to see how the mind could be treated through the
body or the body through the mind, if the body and mind were independent
of each other. The break came when it was found that the administration
of thyroid extract cured the body and the mind of the cretin. The study
of the action of the endocrines seemed to establish the dualism of the body
and mind; but the study of the endocrines themselves refuted the generaliza-
tion. Matter is substance in vibration neutrons, electrons, etc. Substance
cannot be separated from vibration which is a quality of substance. If the
vibration changes, the substance also changes heat changes snow into water,
water into steam, through changes in the vibratory rate. It follows that the
mind is the vibration of the body and that any change in the vibration of
the body (that is, the mind) means a change in the body, and vice versa.
^Published with the permission of the Medical Director, Veterans Administration,
who assumes no responsibility for the opinions expressed or conclusions drawn by the
author.
101
340 GROUP PSYCHOTHERAPY
There is a complete interaction between matter and energy. Man is
body/mind.
The second fallacy was that any man can be an individual free of the
influence of other persons. Primitive Man acted independent of restraint,
gratified his desires and reduced his visceral tensions without considering
the effect of his actions upon his fellows. He was, indeed, an isolationist.
The only man of today, however, who can live in that manner is the one
who leads a nomadic existence in an isolated part of the world, or the one
who has made a, flight into a psychosis. All others feel the impact of their
fellow men and are modified by that influence. They become compound
persons and are represented by the graph: "I / Society. They are indi-
viduals as modified by Society. Indeed, they are a part of Society as well
as being individuals.
Group psychotherapy is often thought of as a new social mechanism.
It is, however, as old as Society itself. Every part of that social organiza-
tion is, in fact, a group treatment. Schools, literature, newspapers, the lecture
platform, music, the theatre, the cinema, bathing beaches, transportation of
material and psychic things, government, the law, religion all social activi-
ties are designed to assist the individual to find an outlet for his personal
activities in methods of conduct which are acceptable to the Herd. And,
finally, when a nation, or people, acting as an isolated individual, conducts
itself in world affairs in a manner inacceptable to other nations, that is, acts
in a manner intolerable to other nations, the result may be war.
These social conventions literature, the theatre, law, religion, etc. are
very complex; but they are all designed to assist the individual in working
out the problems of his simple, primitive emotional reactions. These mech-
anisms have been correlated by the Freudian School and its followers. The
writer of fiction, for example, motivated by personal emotions, portrays a
hero or villain who represents a phase of the author's life; and the reader
puts himself in the place of the hero or villain and profits by the example.
The actor, seeking an outlet for his exhibitionism, assumes a role and the
audience identifies itself with the actor. The present writer once saw an
audience in the Florence Opera House rise as a body, hissing and cursing the
villain on the stage. In another instance a patient could not witness the dare-
devil moving pitcures of Harold Lloyd without breaking out in a cold
sweat, suffering from palpitation and having to leave the theatre to prevent
a physical collapse. The Law tells us what we must do in working out our
102
ANALYTICAL GROUP METHODS 341
personal desires, and specifies what will happen to us if we do not conduct
ourselves in a social manner. The leaders of our churches, having identified
themselves with Christ or with a prophet, assume the self-sacrifice of Christ
or the prophet and become living examples of moral conduct " '
The human emotions are often erroneously thought of as merely
feeling tones or timbre. They are, however, as the word indicates, forms
of movement, agitated and tumultuous. We think immediately of the
clenched fists in anger and hatred. This form of movement is due to the
physical phase, a motion within the body. Every emotion is feeling/action
and is, in fact, a physico-mental mechanism. They are bi-polar since the
vibration of matter is to and fro. They find expression in paired opposites:
Love and Fear. They are many modifications of these two, such as joy
and sorrow; hope and despair; modesty and exhibitionism; rest and fatigue;
and many others. The most important mechanism by which the individual
solves his social problems is that of identification. It is the basis of friend-
ship, pity, charity, and of society itself. Also, unfortunately, of shame,
jealousy, hatred. Into this maelstrom the child is plunged; and as he finds
expression for his emotions, so is his personality.
Despite the constant efforts of Society to fit the individual for social
activities, certain persons are unable to resolve those emotional conflicts
which are destructive to them. The environment has become a source of
fear in its broadest sense and has forced upon them an adjustment which is
periodically or permanently faulty. These are the mental defectives, delin-
quents, psychopathic personalities, alcoholics, psychoneurotics, acute and
chronic psychotics, and other mal-adjusted persons. Some break mentally
with a partially successful solution when forced into a new environment
for which they have no successful solutions such as marriage or war. It is
possible that every man may have his breaking point and be forced out of
adjustment when a new and destructive environment is too prolonged. Many
examples of this type are being seen among the returning veterans of this
War where fatigue, exposure, flying stress, privation, and other debilitating
influences incident to war threw the body/mind out of adjustment. They
reduced its resistance to the destructive fears of shipwreck, flying hazards,
actual combat and all the terrible blitz-krieg and the frightful bombing of
World War II.
A certain percentage of these maladjusted persons make an adjustment
by natural social routes: through experience, reform schools, education offered
103
342 GROUP PSYCHOTHERAPY
by many agencies, gradual changes in the endocrine systems, Alcoholics
Anonymous, religious teaching, and many others. Those who do not adjust
make a flight from Society by remaining introverts, withdrawing to shut-in
occupations or their homes. The most severe are hospitalized in sanitariums
or in mental hospitals. It is for these groups that Society must offer more
drastic methods of treatment.
The group method has the following advantages:
(1) Many patients can be treated at the same time.
(2) The patients become socialized.
(3) The difficulties of the positive transfer are less because the lecturer
remains more impersonal.
(4) Material which is highly embarrassing and stirs up resistance in
individual psychoanalysis, can be presented to the group and be
accepted by the patient.
(5) The patients discuss the lecture material among themselves with
great benefit.
(6) The patients ask questions and during the discussion before the
group many patients will start discussing their symptoms after
having refused to divulge them to the physician.
Some comments on the group method may be made
(1) The writer has learned that the patient is "accessible" at all times
to the correct method of approach. The analyst or psychiatrist
is the only inaccessible person, projecting his own inferiority and
inability to understand the symptoms on the patient.
(2) While the early experiences (Freudian psychology) act as the
drag back, the real difficulty for the patient is a bar to the out-
ward flow of the libido.
(3) Group training without insight fails. The patient must know about
his instincts in order to socialize them.
(4) Insight is the first step toward recovery. But every treatment which
stops here fails. Real cure occurs when the patients bring into
action the corrected, socialized emotion. The body /mind must
be integrated in social activities. Training of the socialized emo-
tion is the second step.
(5) The lecturer starts every talk with the date, place, and purpose
of the talk. Important news may be added.
(6) Daily behavior charts of illustrative cases should be kept.
(7) After the 7th lecture, free discussion is encouraged. Before that,
it is useless and so obviously an attempt to attract attention that
it is resented by the group.
(8) Diagrams representing the flow, suppression and repression of
libido are used throughout the course of lectures.
(9) The lecture of the preceding day is reviewed in abstract before each
lecture.
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ANALYTICAL GROUP METHODS 343
The material and arrangement of the individual lectures which is
used in part or in whole with various groups is as follows:
(1) Introduction. The fear of the new. Tolerance of other points of
view. Geology, the study of the layers of stone on the surface of
the earth. The development of the human body through layers.
The layers of the mind. The paleontologist and fossils in stone.
Repressed experiences, the fossils in the human mind. Self-knowl-
edge is the first step toward recovery. Breakdowns can be pre-
vented and cured. Shame not justified.
(2) The primitive instincts. Bisexuality is a normal condition. Death.
The fear of death the basis of all fears, Fliess: male and female
cycles. Adam and Eve. Urim and Thummin. Yang and Yin.
(3) Heredity. Discussion designed to break down the belief in heredity
as the cause of nervous and mental disorders. Pointed examples
illustrating mental conflict as a cause of physical and mental con-
ditions.
(4) The development of primary images of personality; the man-and-
woman images. Other images of personality. These images as symbols
for masculinity and femininity. The mother and father as symbols
for these images of personality. The mother level. The Oedipus
complex, abstract of the drama, illustrating bisexuality.
(5) Myths and examples of the Oedipus in other races. Illustrations
of the identification of the child with a primary image of person-
ality.
(6) Totemism as an example of racial identification with these images.
Analysis of totemism. Examples of totemism in the play-activities
of children.
(7) The myth of the Birth of the Hero and The Family Romance of
Neurotics, Otto Rank. Examples from life and among neurotics and
the insane, and in the play-activities of children.
(8) Analysis of Kipling's "Jungle Stories" showing the Oedipus com-
. plex.
(9) Analysis of the same showing the hated man-image. Analysis of
Taboo. Examples in the life of the neurotic and insane.
(10) The myths of Echo and Narcissus and other myths illustrating
narcissism or auto-erotism.
(11) Physical narcissism. Lecture devised to break down fears and
misconceptions as to past experiences. Readings from various
authors. The many forms of auto-erotism, exhibitionism, curi-
osity, etc.
(12) Mental and spiritual narcissism.
(13) The development of the ego-ideal and conscience.
(14) Day-dreaming, its mechanisms and great dangers.
(15) Homo-erotism, its development and influence on the individual.
105
344 GROUP PSYCHOTHERAPY
Examples in mythology. Types: aggressive and submissive. Fear
of the man- and woman-images in etiology.
(16) Analysis of the artist and of art. Life of Leonardo da Vinci after
Freud's book of the same title. Pictures illustrating conflicts.
(17) Abstract of Dr. E. J. Kempfs analysis of the psychology of the
"Yellow Jacket."
(18) The inferiority complex. Reading of a lay magazine story illus-
trating the feeling of inferiority.
(19) The feeling of sexual inferiority. Psychosexual inferiority, after
Ferenczi. Other types of sexual complexes.
(20) The guilt complex. Origin of the various phobias.
(21) The shame complex. Self -consciousness. Erythrophobia.
(22) The inadequacy complex. Fear of failure, ridicule, censure, etc.
(23) The physical reactions of fear. Causes of fear and anxiety.
(24) The training of the child; its transitions and goals.
(25) Psychic complexes and mechanisms. Identification, projection, in-
trojection, projection of blame, criticism, elevation and substitution.
Displacement and other mechanisms.
(26) Overcompensation. Its mechanisms and results on a physical, men-
tal, and spiritual level.
(27) Sublimation. Adjustment to the Herd, Altruism. The development
of ethics, aesthetics, and morality. The social conscience.
(28) The causes of failure. The sources of success. Habits and their
formation.
(29) Thrift of money, energy, and time. The minute the most precious
of all possessions. The value of work.
(30) Emotional control and behavior, including the goals of life. The
influence of repressed complexes. Self-study and self-analysis.
The effect of rage and fear in anxiety neurosis, hyperthyroidism,
and epilepsy.
(31) Hygienic living. Alcoholism. Gambling. The responsibility of the
individual as a social animal.
(32) Summary and review.
Throughout the course inspirational material is used. "A Message to
Garcia" is mimeographed and distributed for reading. Other valuable ma-
terial is Kipling's "IF"; "How to be a Failure" by Industrial Peace; "Op-
portunity" by Walter Malone; "Fighter or Quitter" by Grantland Rice;
"Invictus" by Henley; "Analysis of the Psychology of the 'Yellow Jacket' ",
by Edward J. Kempf; quotations from many sources.
Finally, the writer wishes to quote from his article* published in
1921:
"In conclusion the writer holds the ideal that institutions for the insane
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ANALYTICAL GROUP METHODS 345
now largely devoted to custodial care, hydrotherapy, etc., should be changed
into institutions for the instruction of these patients; that such instruction
should aim at directing the instinctive demands, into normal channels aiming
at the heterosexual goal; that defectives not due to organic causes, psycho-
pathic personalities, and the morons should be handled in large numbers by
this method; that young men in criminal institutions, reformatories, under
the care of the Juvenile Courts should be given this instruction, believing
that Society owes it to these patients that they be not allowed to stagnate
in mental inactivity, and that large numbers could by this method be raised
to a sufficiently high level to be of economic value to the community or
return to active life, even if on a lower plane. It is further believed that colo-
nies of these patients should be established looking toward this end. News-
papers should be provided and every method used to assist the patient
back to reality."
*Lazell, E. W., "The Group Treatment of Dementia Praecox," Psychoandt. Rev.>
8: 168, 1921.
107
GROUP PSYCHOTHERAPY
Louis WENDER
Group Psychotherapy is a form of treatment which utilizes a modified
psychoanalytic approach with a group of mental patients. The use of this
method is not advocated as a time-saver. The use of the method is based
on the premise that the patient's early traumatization occurred in a group
(his family), that his subsequent social mal-adjustments were conditioned
by these early traumatizations, and that the group interaction can be utilized
to enable the patient to live out some of his early emotional fixations.
This method is particularly well adapted to an intra-mural setting.
It cannot be used in a hit or miss manner. The entire organization of the
hospital has to be consonant with this plan and permit for the satisfying
functioning of group life. The method is used in conjunction with indi-
vidual therapy and members of the staff are present at group sessions. The
method itself can be described as a modified and active psychoanalytic
approach, in which the director of the group becomes the father-image, the
nurses become mother substitutes, and the other patients are identified with
siblings. These patients remain in the hospital setting for months at a
stretch and their common day-to-day experience can be utilized to provide
the pattern of a substitute home.
This approach must be differentiated from the many group therapies,
in use at the present time, where patients are assembled, given psycho-
logical interpretations, permitted to relate their difficulties freely, and gain
some intellectual insight and a degree of emotional release. Nor can this
method be compared with the technique used in out-patient clinics, where
the patients come from different geographical settings and return to their
OWE homes after a session lasting an hour or two.
The approach to which this paper refers is a form of psychotherapy,
which utilizes psychoanalytic principles in the handling of a group instead
of an individual. The orientation is Freudian, but the therapist assumes
a more active role than the analyst in individual analysis.
The patients suitable for group psychotherapy are those who are in
contact with reality psychoneurotics, mild depressives, and even borderline
schizophrenics. Real psychotics, hallucinated individuals or hypomanics are-
unsuitable. It is essential that the patient have normal intellectual capacity.
Insofar as possible, groups should be planned so that they are fairly homo-
geneous in intellectual and social backgrounds. This is essential to enable
108
ANALYTICAL GROUP METHODS 347
the therapist to place the discussion on a level within these patients' capacity
There are certain pre-requisites to the success of this method. The
therapist must be a familiar figure to the patients, a working member of
the staff. He, in turn, must know his patients and have a real grasp of
their histories and an awareness of their pre-morbid personalities. Patients
should be invited to the first session but the choice of whether they wish
to remain in the group should be theirs. Incidentally, experience over a
fifteen year period, has demonstrated that patients are eager to participate
and that their attendance is faithful.
The leader of the group must be an experienced psychotherapist, who
has a good rapport with his staff and can make this a common professional
venture. His manner must be informal and easy, and he must possess skill
and the ability to set patients at ease, to enable them to verbalize their
problems and ideas, and to relieve emotional tensions in the group.
The group meets in an informal setting 'and the patients are permitted
to relax anpl to smoke. Sessions are held at regular intervals. These sessions
must never be permitted to deteriorate into lectures. Such introductory
theoretical material as is presented, should be utilized largely to achieve
an attitude of objectivity and non-emotionalism about the whole approach.
The presentation of the theoretical material is gauged to the intellectual
and emotional composition of the group. If necessary, to make the material
more concrete and familiar, one discusses physical disease; its cause, the
pathology produced, and the reaction of the human organism to symptom
formation. This analogy finds ready understanding and acceptance. It paves
the way for the description of emotions and how the individual reacts to
the conflicts of conscious and unconscious drives, resistances, early condi-
tioning, sibling rivalries, etc. There is some reference to the unconscious
and the channels through which repressed material is expressed, symbolism
and the role of dreams in our daily life. Hypothetical cases, embracing
some of the features of the patients' own histories, adequately disguised, are
presented. Though the hypothetical presentations and the discussion have
been planned in relation to a particular individual, the discussion does not
focus on him. The therapist approaches this problem generally and evokes
discussion from patients less involved emotionally 'in such a problem. This
activates the group. There is a free flow of ideas from the participants,
resembling free association, 'with production of a good deal of unconscious
material. " :
The patients about whose problem the session has been planned is also
109
348 GROUP PSYCHOTHERAPY
drawn into the discussion. He is not aware that the problem is his own,
nor are the others. He talks freely at times, shedding a great deal of light
on his own problem, expressing repressed hostilities and frustrations, and
producing a good deal of unconscious material. The spontaneity and tempo
of discussion brings forward much revealing material from the other partici-
pants. In this way the leader and the other psychiatrists learn each indi-
vidual's reaction to some problem, his defenses and resistants. The partici-
pation of the staff is valuable because they observe their own patients when
the lafter are not on guard and because the group sessions serve to stimulate
the production of material and enrich the content of individual interviews.
No patient remains withdrawn from the group discussions. Sooner or
later the patient becomes involved. The freedom and spontaneity of other
participants, with whom the patient identifies, overcome some of his resist-
ances. The observations which the leader and staff make are every bit as
valuable as the actual material produced, since they are able to gain some
clues to the patients' resistances and blocs. The leader's role is that of an
arbitrator and observer. He should permit free and easy interchange of
ideas among the participants. Thus, aggression is released and the indi-
viduals give evidence of re-enacting some of their early family conflicts.
He should also encourage the staff members to participate and to give some
of the interpretations requested by patients, as this helps to integrate
the group.
As the group becomes more integrated, tensions diminish. The indi-
vidual begins to view his problem as part and parcel of the general difficulties
of human adjustment. Hostilities, habits, ideas and attitudes that he re-
garded as shameful, repugnant and peculiar to himself, lose their intensity
and secrecy, when viewed against the background of similar problems on
the part of his fellow-patients and universal human adjustment. He begins
to feel that the group the society in which he finds himself is not perfect,
and that frustrations and inferiorities are not uniquely his alone.
In evaluating group psychotherapy, one must bear in mind that there
is no exclusive method that is successful with all kinds of patients. There
are many patients for whomi, group psychotherapy provides a realistic
approach to their difficulties.' ^The entire experience of hospitalization can
be utilized as a process of enabling people who failed in their adjustment
to a larger work to re-test themselves through learning to live in a smaller
one. Obviously, they failed to make the hill of adult adjustment in **high*
gear. ^Jhe re-living experience, enables them to start off again in first gear
110
ANALYTICAL GROUP METHODS 349
and to make the transition to "high". The hospital experience can be
adapted to enable them to re-integrate.'' They have their own organization,
elect their leadership, and make adaptation. In a limited way they learn
to re-adapt to group living; to agree and disagree; to step on people and
to be rebuffed; to express resentments; to accept frustration; and to derive
some satisfactions.
The question is frequently brought up whether a group like the one
described possesses special characteristics beyond those of the individuals
comprising the group, and whether such characteristics further or deter the
patient's recovery. The experience in the armed forces tends to support
the idea that the influence of the group furthers the recovery. Personally,
I am in agreement with Freud, who in "Group Psychology and the Analysis
of the Ego" said that "love relationships (or emotional ties) also constitute
the essence of the group mind"; In my opinion, the group acts toward the
re-awakening of the libido to outside channels. The neurotic has become
introverted and engrossed in himself because of his failure to obtain libidi-
nous gratification from the outside. Group psychotherapy can provide a
medium for re-channeling of libidinous drives to outside objects. The
patient becomes interested in his fellow-patient and tries to help him. He
develops a sense of importance, of being needed. Because he can discuss
someone else's difficulties, his ow$ become lessened. He becomes interested
and his introversion diminishes. ' Perhaps he forms an attachment to the
other patient whom he tries to help, thus releasing his own narcisstic libido.
Gradually, like a child, he discovers the world about him and the satisfac-
tions which he can derive from social adjustment.
Some of the patients who received group psychotherapy have been
followed up for ten or twelve years. Several hundred of them have carried
on an active mental hygiene program through an organization of their own.
While few of them can be cited as brilliant social or economic successes,
the fact is that many of them have made and maintained a social adjust-
ment consistent with their status and capacities.
Ill
NEWER VIEWPOINTS IN THE APPLICATION AND RESEARCfl
OF GROUP PSYCHOTHERAPY*
WLADBOT ELIASBERG
New York City
Our group psychotherapy (2, 3, 5, 7, 8, 9) was devised for the treat-
ment of the skilled, social-democratically organized, unionized, in their
private life more or less settled workers, who rather were small order-loving
bourgeois, conscientious providers, faithful husbands, owners of small sav-
ings accounts, trying hard to give their sons and daughters insurance to
cover education, marriage, etc.
The accident occurs as a very characteristic event in the life of a man,
who from his apprenticeship to his forties in many hard and laborious
years, has not only acquired a particular skill but has built up in himself
a complete motivation toward work and life, comprising both the eight
hours of his working day and his leisure. The sudden breakdown in the
traumatic neuroses touches off piled-up anxieties and causes them to break
through the dams of insurance and reassurance, built up in union contracts,
party politics, etc. In the neurosis, the worker again becomes isolated and
the neurosis is the class struggle of the isolated individual who has felt
subconsciously for quite a time that the political and economic power of
his class is not sufficient and that there is no true compensation for the
insecurity of his life and the incessant endangerment of his most precious
possession, his working ability and capacity.
It is this common background hidden in the subconscious which our
group psychotherapy of the social neuroses has drawn to the fore. (See
Eliasberg, 10, 4.) It would have been wrong from the outset to treat the
social neurosis of the skilled worker like that massive conversion hysteria
of the unskilled worker. Even if they are present, the disease of the former
does not basically consist of conversion symptoms and it is no use fixing
the attention of the patient on pain, weakness, dizziness, feelings of fatigue,
trembling knees, etc. although the social psychological meaning of these
symptoms as losing the ground under one's feet may well be made under-
standable to the patient. But the main thing is that there is a disorder
in the tangible and particularly in the abstract social relationships and
^Because of space limitations the introductory three pages of this article are not
included.
112
350
ANALYTICAL GROUP METHODS 351
those anxieties have piled up just because of these two disorders. (Elia$-
berg 6.)
We all have to orient ourselves upon our fellowmen, whom we
see, hear, smell, rub cheeks with, and on the other hand, upon statutes,
observances, laws, rules, and regulations.; The worker may hate the
foreman as a person but may feel that it is rather the rules which
enforce a certain course of events from dawn to dusk. It is absolutely
not feasible, as well-intentioned companies have tried to do, to reform
only the tangible relationships, to advise the foremen, the engineers,
to be polite and nice to the workers, to make the surroundings dean
and healthy, to have recreation facilities, etc., and to leave the abstract
relationships on which the feelings of security needs rest, unchanged.
It is necessary to find that proportion of tangible and untangible rela-
tionships, that proportion of agreeable personal relationship and co-
ercion which is the appropriate one at a certain time, in a certain
place for a certain population of workers.
Practically we have proceeded in this way. Between two to three hours
were devoted to establishing a mutual acquaintanceship between the patient
and Ms doctor. This can be done clinically, but it is not necessary in each
case to hospitalize the patient. We have experiences with both hospitalized
and non-hospitalized series and no important difference has been observed
which would prove that hospitalization is superior for the treatment of such
cases. While the contact between the psychiatrist and the patient is estab-
lished, and of course a thorough physical examination carried through, he
is being acquainted with the seminar. This can be made easier if such
seminar is already known among those who are in contact with a workman's
sickness or compensation fund. It does not matter that the whole group
should be an "in group" for the total period of the seminar. Newcomers
will easily take up the thread, provided the general homogeneity of the
group is preserved. It has proven valuable to discuss problems of the
economic, social, political, industrial, and maybe organizational and private
life of the workers. 1 As soon as possible the members of the seminar them-
selves should deliver short talks and this should be discussed by the group
with a sociologically and economically trained psychiatrist as the moderator.
It is not desirable that the psychiatrist, instead of being a moderator, acts
as a lecturer. In such a case, failures may be anticipated, as was for instance
the case of the Vaterlaendischer Unterricht in the first World War, which
*Ten years later, P. Schilder has also found that the analysis of ideologies can be
a psychotherapeutic method, especially in group treatment (II, 12).
113
352 GROUP PSYCHOTHERAPY
consisted of lectures given by officers for enlisted men and non-coms who
had to sit by in silence. They considered the whole thing as just one
more branch of G.L service and were by no means disposed to accept it,
(Eliasberg 6.) In other words a factor which must be utilized as soon
as possible is the spontaneous activity of the members. This activity in
a statu nascendi group is very apt to raise the standards of the group as
a whole and the individual members, quite differently from what the older
mass psychologists, LeBon, Tarde, Taine, and Sighele deemed to be the
basic tenet of the lowering of the individual by the group. Shared experience
(Abstraktion durch Ausbreitung im Personnenkreis) as is known since the
time of Socrates, is one of the foremost methods of learning, abstraction,
and social orientation. The mechanism that works in such groups is cer-
tainly not only one of the relationships betweeiN;he members, but also
of transference to the moderator, the treating physician. Nothing must
be avoided by the latter more than class orientation. His neutrality in
questions of the relationships between companies and unions must be defi-
nite. Class struggle as such cannot be abreacted and is therefore not subject
to psychotherapy. We have already mentioned that while the turnover of
manpower in the seminar is not troublesome it is a result of our experience
that class in homogeneous groups cannot be burdened with psychothera-
peutic purposes in social neuroses.
It is, incidentally, interesting that the psychotherapeutic groups which
this author directed have also proven strongly resistant to the rising tide
of the Hitler propaganda. This leads us to the not yet tapped value of
the statu nascendi, as well as pre-existing groups for experimental purposes
and research. 2 The dichotomy of Moore (13), more analytic or more
repressive-Inspirational groups, is for the time being no more than a working
hypothesis.
The factors that should at present be thoroughly examined are those
of self-demonstration, of acting out of conflicts and problems, etc. It
certainly plays a part in the success of our groups that the participants
have to get up, to verbalize what they mean, to speak up for their convic-
tions. The technique of psychodrama will allow of a new approach to these
problems (14). It might especially be expected that the concept of the auxili-
ary egos, as introduced by the psychodramatic theory will prove valuable for
the improvement of both practical results and theoretical insight.
Any group that wants to function as such must become articulate
*See J. L, Moreno's expos6 of Group Psychotherapy, in this volume on p. 77.
114
ANALYTICAL GROUP METHODS 353
through symbols. In education and propaganda this is old wisdom and
because this is so modern propagandists have often been prompted to steal
symbols and to try and do new tricks with old symbols. Whether or not
such plagiarism pays, it shows that there is a belief that symbols create
symbolism and make men into wax so they can be reshaped.
It is certainly not the aim of psychotherapy to take away the self-
determination from neurotics. Nevertheless, symbolism in a psychothera-
peutic group is a topic that has been neglected fairly as much as there is
a need for it. We will not create the symbolic state of mind through
mere signs which we call symbols but we should pay attention to the social
psychological and social economic background of the traumatic neuroses
on the one hand and the pre-existing symbolism thereof. We might also
think of creating new symbols if we feel sure we have a good working
knowledge of that background. See for this Bakke (1). As it is at present,
we will have to do 'much research in this field but the general idea holds
true for propaganda as for psychotherapy: first advertise, propagandize,
symbolize the need and the idea and then show, advertise, and sell the
"goods".
BIBLIOGRAPHY
1, G. Bakke, The Unemployed Man, London. 1933.
2. W. EEasberg, Der Arzt und das Wirtschaftsleben. Report of the
Third Congress for Psychotherapy, Baden-Baden, 1928.
3 B ? Bemerkungen zur Psychopathologie und Psychotherapie der
abhangigen arbeit, Psychologie un Med., 1926, Bd. 1.
4. , The challenge of the social neuroses, /. Nerv. and Men,
Dis., 1941, 94, 676-87.
5. , Grundriss einer dlgemdner Arbeitspathologiej Leipzig,
Earth, 1934.
6. , Psychiatry and propaganda, /. Nerv. and Men. Dis., 1945,
101, 225-41.
7. , Report of the First Congress for Psychotherapy, HaUe,
Marhold, 1928.
8. , Richtungen und Entwicklungen der Arbeitspathologie,
Arch. /. Sozialwiss. u. SozidpoL, 1926, 57, 1 u. 3.
9. } Soziale Probleme der Psychotherapie, Klin. Woch., 1923,
4, nr. 50.
10. , Therapie der Unfallneurose. In Riese, Handbuch der Un~
fallnewose, Stuttgart, Hippocrates vrlg., 1929.
115
354 GROUP PSYCHOTHERAPY
11. P. Schilder, The analysis of ideologies as a psychotherapeutic method
especially in group treatment, Amer. /. Psychiat., 1936, 93, 601 ft
12. , Social organization and psychotherapy, Amer. J. Orthotov-
chiatry, 1940, 10, 911 ff. .
13. M. Moore, The Practice of Psychiatry, Harvard Med. Alumni Bull
1942, 16, S3 ff.
14. J. L. Moreno, Psychodrama and the Psychopathology of interpersonal
relations, Psychodrama Monograph No. 16, Beacon House Beacon
N. Y. '
116
SOME THEORETICAL ASPECTS OF GROUP PSYCHOTHERAPY
NATHAN W, ACKERMAN, M.D.
New York
A theoretical discussion of group psychotherapy, at the present stage
of development, is a hazardous undertaking. I assume this risk with the
utmost humility. While it is true that fools will go where wise men fear
to tread, it is likewise true that, were there no fools, there would also be
no wise men. Therefore, with chastened spirit, and with full awareness of
the relative dearth of controlled clinical and empirical data in this field, I
shall attempt a short discussion of some theoretical principles. In doing so,
I shall lean heavily on my own clinical experience with this form of therapy,
which involved group treatment of Veterans 1 at the Red Cross and group
treatment of disturbed adolescents in my private practice. This background
inevitably implies some wide gaps of factual knowledge, and perhaps some
personal prejudices as well.
It should be understood unequivocally, at the outset, that there are
numerous and diverse forms of group psychotherapy. There are all types
and levels of group psychotherapy, just as is the case with individual psy-
chotherapy. The quality and patterns of emotional contact between patient
and therapist vary accordingly. Such contact may be predominantly on
the supportive level, release level, or insight level, or any admixture of these.
It is only logical that there should be these different levels of treatment
since the therapeutic aim, the role of the therapist, and the actual treat-
ment techniques must be specifically accommodated to the special needs of
distinct personality types, the problems arising out of the patient's social
situation, and also to the particular environment in which the therapy is
conducted.
The specific level of therapy and the treatment techniques applied in
a given case reflect the therapist's aim, which may be: 1) to improve the
adaptation to a specific social situation; or, 2) to relieve certain forms of
acute emotional distress with a view to restoring the pre-existing personality
Psychotherapy with Veterans, presented before the Assn. for Psychoanalytic
and Psychosomatic Medicine, Apr, 3, 194$. Also presented in condensed form before the
Amer. Soc. for Research in Psychosomatic Problems at N. Y. Academy of Medicine
May 11, 1945.
117
see
356 GROUP PSYCHOTHERAPY
balance; or, 3) to produce a basic change in personality organization-
or, 4) any combination of these. Such aims determine the proportionate
degrees in which support, release, reality testing and insight are emphasized
in the therapeutic experience.
In accordance with these differences, the group may be small or large.
It may be homogenous or heterogenous. It may be composed of similar
personality types presenting a common psychological problem, or may be
composed- to some extent of contrasting personality types. The dynamic
equilibrium of the group can be controlled by mingling timid and aggres-
sive types of patients, or on occasion by including a special stimulus in
the form of a particular personality type playing a special emotional role
in the group. Still another variable factor is the social setting in which
therapy is conducted. Depending on whether it is conducted in a hospital,
in an out-patient situation, in a military environment, in a civilian communi-
ty, or in a prison, the therapeutic experience carries a different meaning to
the patient.
All these variables result in differences in treatment method. The
existence of these differences renders the task of extracting some useful gen-
eral principles more difficult. I have neither the space nor the qualifications
for assaying the significance of all these variables, but I do wish to empha-
size the validity of differences in method based on these variables.
In any case, when group therapy is indicated, we have to ask the
further question, what special form of group treatment is appropriate, both
in relation to the unique needs of the patient, and the unique features of
the total life situation surrounding the patient.
Group therapy is, first of all, a special kind of social experience. It
may be exploited for purposes of social re-education of attitudes and emo-
tional drives, in which case, mainly, the conscious organization of behavior
is modified. Or, on the other hand, it may go deeper, stimulate release
of unconscious urges and emotions and catalyze new insight into the mean-
ing of these deeper experiences. In this case it is a treatment in depth
simulating in quality some of the processes involved in psychoanalysis. In
this connection there has been some confusion in the literature as regards
the terms "group work" and "group therapy." Some writers have claimed
identity between these terms and some have claimed a basic distinction.
For purposes of clearer orientation, I believe it is useful to restrict the
term "group work" to processes of social re-education, and reserve the term
118
ANALYTICAL GROUP METHODS 357
"group psychotherapy" for depth treatment involving a systematic approach
to the total personality, involving access to unconscious mechanisms, and
bearing the potentialities for basic reorganization of personality.
Bearing in mind these numerous differences in aim and methcd, I
should like to indicate briefly the features which characterized my method
of group treatment of Veterans. These veterans represented a mixed group
diagnostically. Included in the group were men with social maladaptation,
character disorders (neurotic characters and schizoid personalities), psycho-
neuroses, and psychosomatic disorders. The group was restricted to from
four to eight patients. This limitation was imposed in order to insure ade-
quate emotional contact and continuity in the inter-personal relationships,
both patient-patient and patient-therapist relationships. In the main there
was sufficient similarity in the conflict patterns present in the individual
patients to insure a dynamic basis for the development of empathy and
identification. To this extent there was homogeneity in the group. Beyond
this point, however, there were numerous individual differences in person-
ality, which I considered desirable because it provided an inexhaustible
reservoir of challenging stimuli to the social reactions of the members.
I should add one point: the emotional equilibrium of the group was bal-
anced by including some timid, and some aggressive personalities.
My therapeutic aims were concretely the following:
1) To provide a continuous flow of emotional support through the
group relationships.
2) To activate emotional release in the area of specific anxiety-ridden
conflicts; in particular, to encourage the release of pent-up aggression. This
meant utilizing group psychological influences for the selective reenforce-
ment of some emotional trends and the dilution of others.
3) To reduce guilt and anxiety.
4) To provide opportunity for the testing of various forms of social
reality as personified by individual members of the group, the therapist,
or the group as a whole.
5) To provide opportunity- for the modification of the concept of self
in the direction of increased self-esteem, and recognition of constructive
capacities. This in turn tends to increase the acceptance of other persons
and tolerance for frustrating experience.
6) To foster the development of insight arising from an actual living
out of emotional drives in the context of the multiple inter-personal rela-
119
358 GROUP PSYCHOTHERAPY
tionships within the group. The technique of interpretation was employed
only when the expression of specific emotional trends was sufficiently
solidified.
I wish here to underline one significant point, namely, that the unique
dynamic characteristics of group living impose specific modifying effects
on all partial therapeutic processes, such as we know them in individual
psychotherapy. The processes of emotional support, release, expression of
unconscious tendencies, reality testing, resolution of guilt reactions, and
finally, the acquisition of new insight operate somewhat differently in a
group.
I introduced the Veterans to this new experience by a brief statement
outlining the aim and the method of this form of treatment. Essentially
this was as follows: all the men had been soldiers but they were now experi-
encing difficulties in restoring their place in their families, communities,
jobs, and in their social life, often in their love life. All of them were
experiencing some emotional suffering. Our purpose in coming together
was to freely discuss their problems, their confusions and anxieties, and,
to attempt through mutual help to bring about some improvement. The
patients were asked to be completely candid, and to express their difficul-
ties spontaneously.
They responded by unburdening their personal problems, frustrations,
and fears. They released their pent-up feelings, often acting them out with
a high degree of freedom. They expressed dramatically their wishes and
their hostilities. Their conflicts became more sharply defined; the related
guilt feelings and anxieties were clarified. They used the group experience
as a sounding board for testing the real meaning of their impulses, and
the validity of their particular concepts of social reality.
The activity of the group was patterned motivationally by the patients 7
perceptions of the purpose of the group experience. The therapist personi-
fied this purpose, which was to solve human problems, and lessen emotional
suffering. Certain dominant attitudes emerged which conditioned the "group
atmosphere." This was characterized by a feeling of belonging, a wish to
receive and give emotional support, a tolerance of differences, a tolerance
of weakness, of conflicting emotions, and a mutual striving for better
adaptation.
.The group became something akin to a men's club or fraternity. The
relationship of patient to therapist catalyzed patterns of conflict reminiscent
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ANALYTICAL GROUP METHODS 359
of son-father relationship. In this connection, varying reactions to the
symbol of authority were activated. The members of the group felt each
other as brothers. Corresponding patterns of loyalty and competition
emerged.
Of tremendous importance to these men was the security of belonging.
Because of their dependent tendencies, the need to be accepted by the group
was quite prominent* This was especially conspicuous when the men had
no close family ties and felt emotionally and socially isolated. They sought
a dependable social reality which all too frequently in their real lives was
lacking. Because of this lack, their social values were often confused. The
more aggressive personalities in the group activated the more timid ones.
The passive, submissive patients attached themselves to the stronger ones.
The weakness of some patients invited sharp attack by the more sadistic
ones, or led to veiled flirtations of the homo-sexual type. The retiring
patients envied the more exhibitionistic types, and sought vicariously to
live out their experiences through others. This dynamic interplay provided
an effective basis for therapeutic exploitation.
In this process of spontaneous group discussion, inadequate or stereo-
typed explanations of motivation were challenged. Gradually the layers of
evasion, defense, and rationalization were removed piece-meal so as to
expose the real nature of the reaction. This permitted a dearer view of the
underlying emotional trends and related anxiety patterns. Patients often
interpreted to each other the real meaning of their behavior. Sometimes
this reflected a genuine wish to help the other person; sometimes it rep-
resented merely a sadistic attack, by way of showing up another man's
weakness in order to avoid the necessity of exposing one's own.
It is imperative that such attempts at mutual therapy be controlled
and directed by the therapist in order to achieve the best results. In the role
of therapist, I participated actively in these discussions. I felt the neces-
sity for stimulating empathy between patients, and also for controlling
aggressions in order to preserve the essential unity of the group. This
might be called the stabilizing function of the therapist. I played a role
in catalyzing the release of repressed feeling and channellizing this release
toward a more accurate understanding of the patient's emotional drives.
I employed the technique of interpretation only when the emotional trends
had become clearly crystallized.,
In this particular form of group treatment, I gradually evolved a few
121
360 GROUP PSYCHOTHERAPY
tentative hypotheses, which I am ready to modify with wider experience.
These are as follows: group psychotherapy neither substitutes for, nor com-
petes with, individual psychotherapy. It is an independent method having
certain unique dynamic characteristics of its own, and serves special pur-
poses. The interpersonal relationships in the group are more realistic than
is the case in individual psychotherapy. The group experience offers direct
gratification of certain emotional needs, Group dynamics are more speci-
fically adapted to "externalized" patterns of emotional conflict, namely, those
conflicts in which the struggle is mainly between the person and his en-
vironment, rather than between two opposing forces within the psyche. The
group experience heightens the expression of emotional drives which can
be experienced in common with others. It fosters a living out of emotional
experiences and tends to release tension on a motor level. For adult patients
with serious intrapsychic distortion, it is either contra-indicated or repre-
sents, at best, a partial therapy.
Having come to group psychotherapy through my experience in psycho-
analysis, I have been impressed with certain basic differences in the two
methods. In this brief report I can only suggest the direction in which these
important differences lie. Dynamic trends emerge in the group situation
which either are not present in a two-person relationship, or at least not
in an identical form. Emotional interplay between two persons, such as in
psychoanalysis, provides the potentiality for a social relationship, but it
requires a group of three or more persons to provide a foundation for an
organized social order with dominant aims, ideas, values, and patterns of
interpersonal experience. Of necessity, this fact influences in specific ways
the application of psychotherapeutic principles to a group setting.
In psychoanalytic therapy the patient relives his inner struggle between
his pleasure drives and his anxieties. In this struggle the analyst gives the
patient emotional support, and wittingly or otherwise, takes the side of the
patient's unconscious drives in order to facilitate their release. Simultane-
ously, he endeavors to relieve the pressure of conscience and the inhibiting
effect of reality. In this process, it is part of the analyst's role to personify
reality, both in the context of the patient-therapist relationship and in the
context of the wider outer world as well. Since the patient is unsure of
his own standards, he seeks to rely on the presumably more valid reality
standards of the analyst. But this special role of the analyst in personifying
reality does not always work satisfactorily. In the analytic situation there
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ANALYTICAL GROUP METHODS 361
is no actual social reality against which a patient may measure the impact
of his impulses. It is in this respect that group psychotherapy offers a
special advantage.
In the group situation, the therapist deals with the same three levels
of psychic functioning as in analysis, namely, unconscious drives, conscience
reactions, and reality, but the balance of these forces is different from what
it is in individual psychotherapy. In the group setting, the impact with
concrete forms of social reality is immediate. The patient's accommodation
to social reality can be shifted or modified but can never be avoided entirely.
In psychoanalytic therapy, in contrast, contact with social reality can some-
times be temporarily subordinated or minimized. In a group situation,
adaptation to social reality is a constantly changing phenomenon. The
immediate social reality is a fluid one, because it is variously personified by
one patient or another, the group as a whole, or by the therapist.
Moral reactions and guilt patterns vary tremendously in the group set-
ting. The less rigid types of guilt reactions can be considerably modified
through group psychological influences.
Access to unconscious forces is a variable phenomenon in the group situ-
ation. At times, it is possible to effectively modify unconscious mechan-
isms; at other times, contact with such unconscious forces is difficult to
sustain, and therefore, difficult to work with systematically. In this respect,
individual psychoanalytic therapy has a definite advantage since it is a
means for systematic modification of unconscious behavior.
SUMMARY AND CONCLUSIONS
Group Treatment can be conceived both as social re-education and as a
special form of psychotherapy. It is a special variety of real social experi-
ence, which can be exploited to correct social (reactive) disturbances, per-
sonality disorders of some types, and also, in a positive sense, promote per-
sonality growth. The interpersonal relations in the group approximate
experiences in ordinary social life. The therapist is a more real person than
in the individual therapy situation. The group provides emotional support
for its members. In this setting social reality is a fluid entity, personified at
various times by individual members, the therapist, or the group as a whole.
Group dynamics offer opportunity for free impact between repressed emo-
tional drives and varied forms of social reality, through which the patients
may test the nature of these realities and achieve better understanding of
123
362 GROUP PSYCHOTHERAPY
their impulses. Guilt reactions of the less fixed types can be effectively
modified. Access to unconscious mechanisms is more variable and less pre-
dictable than in individual therapy. At times, therapeutic contact with un-
conscious forces is effective, at other times, difficult to sustain, and in such
instances, the therapeutic results are less reliable.
The form of group treatment I have described offers a useful approach
to some types of social maladaptation and emotional disturbances of recent
origin. It is also a valuable means, within limits, of modifying socially
inefficient defense patterns, and for the analysis of maladapted character
traits, for example, a chronic tendency toward failure, a drive for perfection
and a tendency to emotional isolation. Such group dynamics are better
adapted to "externalized" patterns of conflict. In addition, group influences
can be used to encourage sublimation and reaction formations of a socially
useful type.
To summarize, Group Therapy is an independent method; it neither
competes with, nor substitutes for individual therapy. It is a more real
experience than individual therapy. It is less bound to the irrationalities
of the unconscious and is weighted on the side of allegiance to social
reality Jit is only a partial therapy for the more serious personality dis-
orders. Its powers are sharply limited with personality disorders having
deep unconscious roots. Its greatest effectiveness lies in the area of re-
integration of ego patterns with consequent improvement in the level of
social functioning. For some disturbances of personality it may be use-
fully combined with individual therapy.
124
PSYCHODRAMAHC METHODS
PSYCHODRAMA IN AN EVACUATION HOSPITAL
BY ERNEST FANTEL, Captain, M. C,
138 Evacuation Hospital, U. S. Army
INTRODUCTION
This is a preliminary report concerning the psychodramatic work in
an evacuation hospital. The 138 Evacuation Hospital, a 400 bed installa-
tion, was stationed for several months In Trier, Germany, in a building which
had formerly been a civilian hospital. Because of its good facilities, it was
made a center for neuropsychiatric cases, and the surrounding hospitals
evacuated their cases to us. We had a daily average of 30 psychiatric pa-
tients, none of whom was allowed to remain more than five days.
The technique of J. L. Moreno was used, but our work was performed
under the improvised conditions found in a theater of operations. No stage
or theater was available. We did our work in our office, a large room about
20 feet square, furnished with a desk, a table, one couch, a closet, and
several chairs. The floor was covered with a carpet, which made it easier
to reenact scenes that had originally taken place on the ground.
A history was taken of every patient, and the Kent EGY intelligence
test was given routinely. It was surprising to see that even soldiers whose IQ's
placed them in the moron group could be easily induced to act. No narco-
synthesis with sodium pentothal or sodium amytal was used. Because we
had no time to reenact systematically the entire history of each patient,
we limited ourselves to reenacting the highlights of each case.
Before each scene, according to his level of intelligence, the patient was
given a short talk explaining what we were planning to do, telling him
not to be afraid of the audience who would keep all that transpired confi-
dential. The subject was asked to describe in detail the locality and to
identify the position of each landmark with some object in the office. In
this way the corner of the closet would become a street corner behind which
he would see dead people, our desk would become his commanding officer's
desk, and so forth. It was surprising to see how much importance the pa-
tients themselves attached to the proper arrangement and re-arrangement of
the furniture to fit the original situation, and how much it disturbed them
to see anything out of place.
125
364 GROUP PSYCHOTHERAPY
Doctors, nurses, and wardmen acted in supporting roles helping to re-
create the characters involved in the original situation (auxiliary egos).
In a few instances the original partners were available to act as auxiliary egos.
Many patients have a tendency to be narrators rather than actors. We
induced them to act as much as possible. No script was used and all acting
was impromptu. After each session we had a short discussion and analysis
with the patient, trying to tell him what we had been able to learn and how
it helped to understand his case.
No strict and uniform technique was used. We varied our procedure to
suit each individual situation.
THE DRAMA AND OTHER FORMS OF PSYCHOTHERAPY
Let us consider other forms of psychotherapy and their relation to the
drama.
HYPNOSIS
In hypnosis a scene can be suggested to the patient and he can
be asked to act in a certain role. For instance, he can be told that
he is in a garden picking flowers. The subject will rise from his bed as
if he actually saw flowers around him, and he will go through the motions
of picking imaginary flowers. Upon being told to give them to the hypno-
tist, he will pretend to do so, stretching forth his empty hands as if to make
a gift. In other words, we can consider hypnotism as a dramatic perform-,
ance of the person who has been hypnotized.
It has long been a question whether the subject is really asleep.
Experiments by Jenness and Wible in which blood pressure, respiration, and
other vital functions of the patient during hypnosis were compared with
those during sleep, showed that the hypnotized person is really awake. He
is engaged in psychodrama without knowing it. When we ask our-
selves whether hypnotism is a suitable form of psychotherapy insofar as
the psychodramatic procedure is concerned, we must realize that it has two
strong drawbacks.
First, not every person can be hypnotized. It is easier to tell the sub-
ject to pretend to be picking flowers than to go through the same perform-
ance via hypnotism. And secondly, the role of sleeping sometimes inter-
feres with the acting. Some people will be so deeply hypnotized that they
will not get up when told that they are in a garden, but will continue to lie
down while reaching into the air as if picking and handing you imaginary
126
PSYCHODRAMATIC METHODS 36S
flowers. Others will walk around with their eyes closed and their hands
outstretched, the way they imagine a sleepwalker should act. Obviously,
all this interferes with the psychodramatic action which we want the patient
to perform.
PSYCHOANALYSIS
Psychoanalysis has retained from hypnotism the position of the patient.
He reclines, is asked to relax and not to move. There are far more restric-
tions and inhibitions than in hypnotism, in which the patient has freedom of
movement once he has been hypnotized. All associations are on a verbal
level only.
PSYCHODRAMA
In the psychodrama, the process on the stage has all dimensions. Some
people are not very skilled m. expressing themselves by means of the spoken
word, but often a slight movement of the body, like bending the head or
taking a step backward, can mean much more than words can express. Asso-
ciations can be brought back in this way which would be impossible to re-
cover by other methods. We have therefore, in the psychodrama, a method
fa \JtACj
for the breaking of amnesia far ttp!S|iOTto any technique on tbe verbal
level. If we reconstruct the locale in the mind of the patient by suggestion,
then give him freedom dtf the stage Smtl gurh mrrilfrrcy eges-a&^may ba~ie-
qtt&ed, he will suddenly Temember a continuity of events which otherwise
seems to have passed completely out of his mind.
In psychoanalysis a very important factor in the treatment is the de-
\jdopment of transference. It takes a long time before the physician as-
smnes for the patient the requisite auxiliary identity, and it is important
that after a certain period this transference should be broken in order to
achieve a cure. We can see that such a devious approach is far surpassed
if we suggest to the patient directly that he accept the auxiliary ego in his
assumed role. The patient understands that this is only an imaginary func-
tion for a limited time and that as soon as the session is ended the auxiliary
ego assumes his real life identity. We can assume many different roles
which are important in the person's problem, and we can break each as
rapidly and as easily as we created it. If at all possible the original charac-
ters in the interpersonal problem can be asked to appear on the stage and
to act in their real identity. The physician does not need to assume any
identity at all, merely directing the drama.
127
366 GROUP PSYCHOTHERAPY
NARCOSYNTHESIS
In this war this method of psychotherapy has come very much to
the fore* Sedatives are used to overcome the resistance of the patient
in revealing his repressed traumatic experience. In Grinker's excellent
book, War neuroses In North Africa, we see that under the influence of
drugs such as sodium pentothal, patients often relive battle experiences
in a very dramatic fashion. They crawl on the floor as if they
were dodging bullets overhead; they go through the motions of digging
a foxhole, etc.
Although some of the sedated patients will readily get up and act,
others will be too drowsy because of the hypnotic and will continue to
lie down, giving only a verbal account of their story. The chemically in-
duced sleep here interferes with their acting just as the suggested sleep is
a handicap in hypnosis. Also, the fact that we might have to keep the
syringe in the patient's vein to regulate the depth of the narcosis interferes
with his freedom of movement. We think it is far better to ask the patient
directly to reenact the traumatic experience. Although he might be resistive
at first he soon warms up and is carried away on the stage and we can re-
enact his past far better than if he were half asleep from a drug.
GROUP PSYCHOTHERAPY
The term "Group Psychotherapy" introduced by Moreno having recently
become popular, has been used so loosely that its meaning has become am-
biguous, Most people regard it as a form of mass treatment in which
several subjects with similar problems can be treated simultaneously.
Technically, group psychotherapy can be accomplished by various means,
such as lectures, group discussions, and psychoanalysis in groups. The
psychodrama can be used for such mass treatments, because it is easy to
assemble an audience suffering from similar problems. Either a "prepared"
psychodrama can then be performed for their benefit or they can watch a
patient treated on the stage with a condition similar to their own, A
cathartic process takes place in the audience as they watch the proceedings*
on the stage (catharsis of the spectator).
It would seem that the psychodrama deserves to be considered as the
most advanced form of group psychotherapy for another and even better
reason. It is the only form of treatment known to date in which the malad-
justments of a group of people can be treated at one time. The other forms of
treatment such as psychoanalysis, treat only the maladjusted- individual, 4he
128
PSYCHODRAMATIC METHODS 367
. The analyst for instance pays attention only to the child in
ps situation, neglecting the parents who come into the picture as verbal
shadows only. The psychodrama permits placing parents and child opposite
one another on the stage. In the same way if there is a conflict between hus-
band and wife, officer and enlisted man, both can be brought on the stage at
the same time. In theory there is no limit to the number of people who can
participate in such a situation and each one of them will be able to partici-
pate in all three forms of catharsis. (See below),
What are the therapeutic mechanisms of the psychodrama? They are
Matemlizatian. Catharsis, Insist, Trailing and Ad^ptatjon.
1. MATERIALIZATION. The psychodrama gives the mental pa-
tient an opportunity to give materialization to his imaginary world. The
outcast, whose ideas were laughed at and rejected, gains a new feeling of
acceptance and self-assurance. The theatre will give reality to pleasant
phantasies, providing the patient with a wishfulfillment. It also will give
a crystalization to vague fears and anxieties. These now gain substance
and reality, so that the patient can face them, struggle with them, and
overcome them.
2. CATHARSIS. Aristotle has formulated the concept of catharsis as
a process which takes place in the mind of the spectator of a drama.
Moreno has elaborated on it and distinguished three forms of catharsis: The
first form of catharsis takes place in the author, the creator of the drama,
In writing the play he gets many things "off his chest." The next recipient
of catharsis is the actor who inter^?5l5tes his own experiences into the role
which the author created. The thir^ ree^Bt is the spectator who experi-
ences a catharsis in the Aristotelian sense.
In the psychodrama the patient is the recipient of all three forms of
catharsis at one time. He is the creator, the actor, and the audience in one
person combined, thereby deriving a maximum benefit.
3. INSIGHT. The psychodrama, by dramatizing the highlights of
each case, provides a synopsis aftd panuumlc view to the patient of his
own difficulty. This, with the discussion following each scene, gives him an
insight into the mechanism of his illness.
4. TRAINING AND ADAPTATION. The security of the stage pro-
vides an opportunity for training. The patient knows that he is safe in the
imaginary world in which no harm or ridicule can come to him. The confidence
acquired on the stage can then be carried over to real life.
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368 GROUP PSYCHOTHERAPY
CASE HISTORIES
CASE A
BRANCH OF SERVICE; Cavalry.
PLACE OF BIRTH: North Carolina farm.
AGE: 30.
OCCUPATION OF FATHER: Farmer.
FAMILY HISTORY: Mother died when patient was very young.
Patient had five brothers and sisters, all dead.
HOME LIFE: Patient's father remarried, and the patient's stepmother
treated him well.
EDUCATION: Only first grade was completed, because the patient
had to begin work at an early age. He is illiterate, except that he can sign
his name.
CIVILIAN OCCUPATION: Odd jobs, mostly on farms.
DATE OF INDUCTION: April 6, 1942.
ARMY LIFE: Private first class; rifleman; in E. T. 0. five months.
In combat in Germany about one month.
COURT MARTIAL: One for drunkenness.
MARITAL HISTORY: Married and happy. One child living, one
dead.
SOCIAL DISEASES: Denied.
ALCOHOLISM: Patient states that he gets drunk about twice a year,
when someone gives him whiskey. He never buys whiskey himself.
DRUG ADDICTION: Denied.
CIVILIAN ARRESTS: Only once, for speeding.
KENT EGY TEST: IQ SO. MA iy 2 . Moron level.
PRESENT ILLNESS: Patient states he has been hearing voices for
the past six weeks. The voices moan and groan, but he can not make out
what they say. "It is the guy I killed. I see him too." The patient was
referring to an incident about six weeks previously when he had been on
guard duty on the Rhine.
A German soldier tried to come upon the bridge guarded by the patient,
who had to shoot him. Although hit twice in the chest, the German tried
to get to his feet. Another American soldier on guard with the patient,
shot him down. The patient said that although he had killed six men in
combat, this was the only one that bothered his conscience.
PSYCHODRAMA: The crucial scene in which the patient had killed
130
PSYCHODRAMATIC METHODS 369
the German was recreated with much realism. A ward man played the role
of the German soldier, crouching and approaching the patient, and after
having been "shot", writhed on the floor moaned and groaned. The
patient said, "Please don't do that. That is how he looked when he died,
I can see him in my sleep, on guard, or whenever I am alone. I sit down
and wonder if that man will ever get off my mind. He just walks across
the road in front of me. He never talks, but just moans and groans."
The ward man got up, walking in front of the patient who shut his
eyes. After the session was over, the patient was breathing hard and was
very much affected. The same episode was repeated on several successive
4ays and the patient gradually lost his fears. He was constantly afraid of
finding bodies in the hospital, say, in the basement under the ward. So we
initiated a program of training to familiarize him with dead bodes. We
acted out several scenes in which an assistant played the "body", making the
patient touch the body, handle it, turn it around, etc. At one time the patient
was placed in the role of an undertaker. At first he showed great reluctance
to touch the "body" but we pointed out to him that he was only an actor.
In time the patient overcame his fear of the dead, and thus received bene-
ficial training.
An interesting aspect of the case is the manner in which the patient
at first carried on the dramatic situation after he left the office and avoided
the auxiliary ego, the physician who had played the "body".
He also developed a fear of the office, the room in which he had seen
the bodies. Observing this, we incorporated into our treatment a scheme to
help him to overcome his fears. We had the auxiliary ego frequently visit
the ward, walk over to the patient, smile and shake hands.
We also placed the patient in the role of a father and an auxiliary ego
(the nurse) in the role of a child afraid of ghosts. The patient had to
comfort the child and tell her that there are no ghosts.
DIAGNOSIS: Psychoneurosis, anxiety state, severe.
PROGRESS: Improved.
DISPOSITION: Evacuated to a general hospital.
CASES
BRANCH OF SERVICE: Combat Engineers.
PLACE OF BIRTH: New Jersey.
AGE: 46.
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370 GROUP PSYCHOTHERAPY ^
OCCUPATION OF FATHER: House painter.
FAMILY HISTORY: An uncle ("He looked like me,") suffered from
a mental disease. His father was a drunkard.
HOME LIFE: Patient's father, a drunkard who died last year, used to
''beat the hell out of" the patient who often had to bring him home because
he was so intoxicated that he could not walk.
EDUCATION: Completed the eleventh grade, after having had to re-
peat the second and the seventh.
CIVILIAN OCCUPATION: Steeplejack, painter, factory worker, me-
chanic*
DATE OF INDUCTION: November 11, 1943.
ARMY LIFE: Private in combat engineers; in E, T. 0. since Decem-
ber, 1944. In combat two months.
COURT MARTIAL: None.
MARITAL HISTORY: Happily married, but has no children.
SOCIAL DISEASES: Denied.
ALCOHOLISM: Denied.
DRUG ADDICTION: Denied.
CIVILIAN ARRESTS: Denied.
KENT EGY TEST: IQ 82. MA 11. Borderline intelligence.
PRESENT ILLNESS: Patient saw his father die in October, 1944 after
an operation for cancer of the lung. He said that he had not been the same
since. After he arrived in England his behaviour attracted the attention
of his commanding officer. The patient often seemed frightened, would walk
away and appear depressed, strolled through mine fields, had nightmares,
saw fire balls and snipers creeping up to him. He talked in his sleep, awaken-
ing in terror, and smoked countless cigarets the rest of the night. He heard
voices, particularly that of his wife, saying, "Aren't you ashamed?" He
heard music and bells ringing. He often cried. He was admitted with a
diagnosis of dementia praecox.
The preliminary interview revealed that he had once come upon the
body of a dead soldier, a combat casualty, lying in a crater, with only his
head exposed and half of it had been blown away by the force of the ex-
plosion. The patient also indicated that he always had the feeling that
he was being watched or followed by someone, but when he turned
arociwi ao one was there. He also saw faces which were nebulous or like
shadows. "I look at a can on the stove and it turns into a face lau
132
PSYCHODRAMATIC METHODS 371
at me. It has fangs like a cat, and only one eye." He was so afraid of this
ghost that he refused to go to bed the first evening that he was in the hospi-
tal, asking to remain up with the attendants.
PSYCHODRAMA: The first psychodramatic scene was an attempt to
give substance to the nebulous shadows which were watching and follow-
ing the patient. An auxiliary ego, a physician, followed him as he walked
about the room. At every step the patient turned around to catch a better
glimpse of this shadow. Each time this occurred, the "shadow" jumped away
quickly. The patient was very much shaken by these realistic episodes.
He was taught to turn around and face the man who was following him,
to challenge him, and to touch him.
Another scene v was reproduced in which -the patient recreated the
episode in which he came upon the dead soldier. The assistant, another
physician, was placed on the floor in the position of the dead soldier, the
patient making certain that all details were scrupulously observed. He seemed
very frightened and upset when faced with the body, which, with only one
eye open, had the likeness of the "ghosts" he used to see. After much hesi-
tation and resistance he was finally able to comply with commands to
handle the body.
We also improvised scenes in which the ghost (the auxiliary ego)
jumped at the patient from corners and he had to fight and wrestle with
him. To let the patient gain confidence in himself, we let him be the victor
in these sham fights.
In order to make him lose his fear of bodies which he was afraid of
finding almost anywhere, we placed him in the role of an undertaker (as
in case 4) and he had to pretend he was embalming a body. At first the
patient was so afraid of the body that he hid behind a cabinet to avoid
looking at it. He gradually lost his fears and even developed some bravado
as an imaginary undertaker.
PROGRESS: Improved.
DISPOSITION: The patient was evacuated to a general hospital.
CASEC
ORGANIZATION: Infantry.
PLACE OF BIRTH: Farm in Tennessee.
AGE: 26.
FAMILY HISTORY: Father died of tuberculosis when patient was 17.
133
372 GROUP PSYCHOTHERAPY
HOME LIFE: Normal.
CIVILIAN OCCUPATION: Farmer.
DATE OF INDUCTION: May 25, 1943.
ARMY LIFE: He took a three months' army course to learn to read
and write. Rifleman, in E. T. 0. one year. In combat three months in
France, Belgium and Germany. Received Purple Heart for wounds of left
hand.
COURT MARTIAL: None.
MARITAL HISTORY: Married, but has no children.
SOCIAL DISEASES: Denied.
ALCOHOLISM: Denied.
DRUG ADDICTION: Denied.
CIVILIAN ARRESTS: Denied.
KENT EGY TEST: IQ 82. MAIL Borderline intelligence.
PRESENT ILLNESS: "A buddy and I were in a foxhole in the Huert-
gen forest without food or water for three days and nights, taking an awful
beating from German artillery and small arms fire. When I went back alone
on the fourth day for K rations, the Germans counter-attacked. Some were
coming from the foxhole where my buddy and I had been dug in 100 yards
in front of the rest of the company. We never did see him again. While we
were in the foxhole my buddy was always telling me about his girl friend
back home, whom he loved very much and whom he planned to marry when
he got home again. We would also say many prayers day and night hoping God
would have mercy on us so we could get home again. But I suppose he
was killed in that counter-attack and will never see his girl again." The pa-
tient appeared anxious and tense. He complained that his heart was beating
"like a sledgehammer" when he lay down, also about nausea and vomiting
after each meal. He showed a marked tremor of his fingers and hyper-
hydrosis. He stated that he often had nightmares and would wake up
bathed in cold sweat.
PSYCHODRAMA: The episode in the foxhole was reenacted. One
of the wardboys acted as his buddy and they talked, crouched and prayed
as they had done in the real situation. The patient acted very realistically,
and seemed to obtain great relief from the process.
DIAGNOSIS: P&ychoneurosis, anxiety type.
PROGRESS: Much improved.
DISPOSITION: The patient was evacuated to a general hospital as he
seemed to be in need of more rest and unfit for further combat duty.
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PSYCHODRAMATIC METHODS 373
CASED
BRANCH OF SERVICE: Quartermaster corps.
PLACE OF BIRTH: Farm in Illinois.
AGE: 28.
OCCUPATION OF FATHER: Farmer.
FAMILY HISTORY: Without significance.
HOME LIFE: Normal.
EDUCATION: Finished eighth grade at the age of 16. Repeated
third and fourth grades. Took lessons to correct stuttering.
CIVILIAN OCCUPATION: Farmer and factory worker.
DATE OF INDUCTION: December 19, 1943.
ARMY LIFE: Private, infantry. In E. T. 0. since November, 1944.
In combat for six weeks in Belgium.
COURT MARTIAL: None.
MARITAL HISTORY: Details given later.
SOCIAL DISEASES: Denied.
ALCOHOLISM: Gets drunk occasionally.
DRUG ADDICTION: Denied.
CIVILIAN ARRESTS: Denied.
KENT EGY TEST: IQ 93, MA 13. Dull normal.
PRESENT ILLNESS: He accidentally shot and killed a 12 year old
girl during a street fight in a small Belgian town. He carried her for sev-
eral blocks to the nearest aid station, but she died in his arms. This inci-
dent is constantly on his mind. It takes him a long time to fall asleep and
he wakes up with nightmares. His stuttering has become worse. His hands
tremble and he bites his nails. He stated that he will never be able to face
his wife again, although he had previously given the information that he
was not married.
PSYCHODRAMA: The scene in which he killed the Belgian girl was
reenacted with a nurse as the auxiliary ego. At first he seemed somewhat
embarassed about the idea of carrying a nurse in his arms, but adjusted
quickly and reenacted the scene very realistically. Tears came into his eyes
and he said, "I have a little girl, too."
We then reproduced the highlights of his life. He had married a girl
of 16 despite the objections of her parents, who were particularly opposed to
him since she was a Catholic and he was Protestant. An annulment was
obtained. He did not see his former wife until just before he went over-
seas, when she told him that she was pregnant and asked him to many her
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374 GROUP PSYCHOTHERAPY
again. However he refused under the pretext that life during wartime was
too uncertain. Her child was born while he was overseas. He has written his
former wife only twice since he left the States.
We interpreted this case as one of transfer of guilt. The patient's re-
sponsibility for the death of the Belgian child became confused in his mind
with the death wishes which he subconsciously had against his own unwanted
child, and by the feeling of guilt occasioned by refusing to remarry the
mother of his child. This was explained to the patient.
DIAGNOSIS: Psychoneurosis, anxiety type.
PROGRESS: Much improved.
DISPOSITION: Returned to his unit.
CASES
BRANCH OF SERVICE: Infantry.
PLACE OF BIRTH: Small town in Illinois.
AGE: 27.
OCCUPATION OF FATHER: Insurance agent.
FAMILY HISTORY: No neuropsychiatric determinants.
HOME LIFE: Normal.
EDUCATION: Finished two years of high school.
CIVILIAN OCCUPATION: Clerk.
DATE OF INDUCTION: November 6, 1942.
ARMY LIFE: Sergeant in infantry. In E. T. 0. nine months. In
combat two months in France.
COURT MARTIAL: None.
MARITAL HISTORY: Happily married four years to a woman six
years his senior.
SOCIAL DISEASES: Denied.
ALCOHOLISM: Denied.
DRUG ADDICTION: Denied.
CIVILIAN ARRESTS: Denied.
KENT EGY TEST: IQ 100+. MA 14+. Average intelligence
PRESENT ILLNESS: This patient suffered from a severe depression
for two weeks prior to his admission. He cried often and stood about aim-
lessly for hours at a time. He refused to eat, stating that he had no appe-
tite. His primary difficulty was one of loneliness. He thought about his
wife and cMTd constantly. She appeared before him at night and he talked
with her before faffing asleep. He also saw her in his dreams.
136
PSYCHODRAMATIC METHODS 375
PSYCHODRAMA: We thought it would help the patient to bring his
wife back to him, even though it was only in make believe. With the help
of a nurse we reenacted some of the events which had occurred since he
had met his wife. In the first scene he acted out how he had met her. At the
time he was in a hospital with a broken leg and she was his nurse. They
acted out how they talked while she was taking care of him, taking his tem-
perature, rubbing his back, etc. In other scenes he talked with her at the
night desk after he was better; how he met her at the nurses' home after he
was released from the hospital. In one scene he took her to a dance and
she wore an evening gown. He said he had never seen anyone more beau-
tiful. Other scenes reviewed his conversations with his wife at various places
as on a park bench, in the foyer of the nurses' home, where they talked about
plans for the future. During one of these he asked her to marry him. She
objected because he was younger, but he overrode her arguments. They
acted out many scenes of their daily married life, how they got up in the
morning, how they had breakfast, how she met him after work, etc. In one
scene she told him she was pregnant. In another scene he walked back and
forth nervously in the fathers' room until he learned that their baby had
been born. They reenacted some quarrels. For instance, he wanted to go
out and his wife did not, saying she had too much work. He reproached
her saying she was becoming almost like his mother. Finally we reproduced
several scenes portraying his homecoming after the war, with his wife and
child meeting him at the railroad station.
Psychodrama, of course, cannot solve a problem which is the necessary
result of the vicissitudes of reality. It cannot, for instance, bring this man
and wife together if the war keeps them apart, but it can at least give them
realization of the wish on the stage of an imaginary world.
DIAGNOSIS: Psychoneurosis, Reactive depression.
PROGRESS AND DISPOSITION: The patient obtained great relief
during these sessions. It was the first time we ever saw him smile. He
became very much attached to the nurse. He was discharged to duty in a
few days.
CASEF
ORGANIZATION: Quartermaster Service Company.
PLACE OF BIRTH: Shreveport, Louisiana.
AGE: 29.
RACE: Negro.
137
376 GROUP PSYCHOTHERAPY _
OCCUPATION OF FATHER: Railroad foreman.
FAMILY HISTORY: His father suffered a stroke in 1936 which para-
lyzed his right side. His mother was crippled by arthritis. His grandmother,
who lived in the house with him, was 80 years old and had great difficulty
in walking even with a cane.
EDUCATION: Repeated the sixth grade and finished the ninth.
CIVILIAN OCCUPATION: Mechanic in a defense plant.
DATE OF INDUCTION: October 12, 1942.
ARMY LIFE: Private. In the K T. 0. six months.
COURT MARTIAL: Once for having been AWOL.
MARITAL HISTORY: Single.
SOCIAL DISEASES: Gonorrhea in 1939.
ALCOHOLISM: Drinks frequently.
DRUG ADDICTION: Smoked two marijuana cigarets daily but could
not get any in Germany.
PRESENT ILLNESS: Patient was admitted with weakness of the right
leg which had appeared two weeks prior to admission. He walked with a cane.
Physical examination showed no abnormalities other than a slight tremor
of the fingers. Laboratory and X-ray findings were normal.
KENT EGY TEST: IQ 73, MA 10, Borderline intelligence.
PSYCHODRAMA: The patient was asked to demonstrate how his
father walked. He walked with a cane, dragging his right leg behind him,
just like the patient himself had been walking. He also showed how his
mother and grandmother walked. After this demonstration it was easy to
convince him that his present symptoms were merely an imitation of the
characteristic gaits of the various members of his family.
While this patient was in the hospital, another patient happened to be
on the same ward who likewise suffered from a hysterical paralysis. Both
patients were called into the session together. One was given the role of
the doctor and told to sit at the ward officer's desk. The other took the part
of the patient. The "doctor" was instructed to tell his "patient" that all
necessary examinations had been made and were negative and that his con-
dition must be a matter of the mind. This was thoroughly explained to the
patient until he felt that he really understood this psychodramatic mech-
Then we gave the "go ahead" for the scene. The nurse introduced the
sew "patient" to the "doctor" and the patient gave all his actual complaints
138
PSYCHODRAMATIC METHODS 377
about his paralysis. Then the "doctor" explained in his own words, and to
the best of his ability, what he had been instructed to say. He was thus
forced to give an explanation for symptoms that were really his own. Then
the two patients exchanged their roles and repeated the scene. This is a psy-
chodramatic technique which we often used because it is easy to apply,
DIAGNOSIS: Psychoneurosis, conversion hysteria.
PROGRESS AND DISPOSITION: The patient showed marked im-
provement and rejoined his unit after five days in the hospital,
CASEG
BRANCH OF SERVICE: Ordnance, tank repair,
PLACE OF BIRTH: Bedford, Mass.
AGE: 32.
OCCUPATION OF FATHER: Engineer.
FAMILY HISTORY: No mental disease.
HOME LIFE: Youngest of five children. Parents got along together.
EDUCATION: At the age of five he suffered a skull fracture and a
chest injury in an auto accident. He was hospitalized seven months with a
draining empyema. He attended a special school where he received indi-
vidual attention and much rest.
CIVILIAN OCCUPATION: Messenger boy, bus boy.
CIVILIAN ARRESTS: Three times. At the age of 14 he stole a car
together with some other boys, but received only a suspended sentence. At
16 he received a 38 months' sentence for breaking open a safe, and served at
the Concord Reformatory from the age of 16 to 19, when he was paroled.
He broke his parole and went to New York where he worked as a messen-
ger boy and as a bus boy. He was picked up by police on suspicion of
murder, released on that charge, but retained for having broken his parole.
MARITAL HISTORY: Married a waitress and had two children. The
second child was born while he was in prison. After his return, his wife
would have nothing more to do with him. After he was inducted into the
army, he visited her on a furlough and then she agreed to a reconciliation.
DATE OF INDUCTION: 1943.
ARMY LIFE: Unsatisfactory. Rehabilitation camp for six months at
his own request, to avoid dishonorable discharge. Carpenter, TS.
COURT MARTIAL: In September 1944 he had a ten day furlough
and went on a drinking spree because he was "disgusted with everything."
He overstayed his furlough 27 days, was court martialed, and spent six
139
378 GROUP PSYCHOTHERAPY
months in the guard house. He escaped but was picked up in four hours,
He said it was planned to give him a dishonorable discharge, but that he
pleaded to stay in the army. He was sent to a rehabilitation center at Fort
Jackson, South Carolina. There he joined his present unit and accompanied
it to the E. T. 0.
ALCOHOLISM: Patient had been drinking just prior to admission
to the hospital and admitted being a heavy drinker.
DRUG ADDICTION: Denied.
KENT EGY TEST: IQ 73. MA 10. Borderline intelligence.
PRESENT ILLNESS: On admission he was suffering from abdominal
pain in the right upper quadrant, which was suggestive of biliary colic.
He felt well the next day and had no jaundice. X-ray and laboratory find-
ings were normal. The patient was discharged, but was readmitted on the
same day "in a semi-stuporous state, and answered questions only by nod-
ding or shaking his head." He had no injuries or bitten tongue; his pupils
were moderately dilated and equal. He soon regained consciousness and
appeared normal in every way.
PS^CHODRAMA: The following day the soldier's company com-
mander came to inquire about his condition. We asked him about the inci-
dents immediately preceding the patient's seizure, and he agreed to help re-
enact the original scene. The captain explained that after the patient
had been returned to duty, he came to the company office asking for a
different assignment. He was dissatisfied as a carpenter and asked to be
placed in the motor section. The captain answered the request in a non-
committal way, which the patient regarded as a refusal. Immediately fol-
lowing the interview, the patient became very pale, began to perspire, fell
to the floor, and his hands and feet shook.
An ambulance was called and took him to the hospital. After a few
introductory scenes in which the events in the patient's life and the scene in
the carpentry shop had been reenacted, the scene in the company comman-
der's office was portrayed. Both the captain and the patient were asked
to use exactly the same words that they had used originally and to enlarge
on them with what they were thinking. During the acting the patient sud-
denly became pale, asked to lie down on the couch, perspired, and his arms
and legs shook. We were surprised to see that when we told him "The scene
is over aw" he immediately stopped shaking and arose to talk with us.
The captain said that the psychodramatic attack was a close duplicate
of the original.
140
PSYCHODRAMATIC METHODS 379
Very often a psychodramatic attack can be terminated at mil merely
by exclaiming "Stop!" to the patient. We regard this possibility of acquir-
ing a faculty to reproduce certain states and then to break away from these
states at will as the acquisition of valuable control.
DIAGNOSIS: Psychoneurosis, conversion hysteria.
PROGRESS: The patient had no more attacks and we had no further
difficulty with him.
DISPOSITION: Returned to duty.
CASEH
BRANCH OF SERVICE: Infantry.
PLACE OF BIRTH: Cleveland, Ohio.
AGE: 25.
FAMILY HISTORY: Both parents highstrung. A brother was rejected
from the army for neuropsychiatric reasons.
OCCUPATION OF FATHER: Salesman.
HOME LIFE: Parents quarreled frequently, usually because the
father was interested in other women.
EDUCATION: High school graduate. Was a timid child, blushing
easily, afraid to recite in class; often became ill before examinations, some-
times developing "convulsions."
CIVILIAN OCCUPATION: Clerk.
DATE OF INDUCTION: February 22, 1943.
ARMY LIFE: Corporal in the infantry. In the E. T. 0. 7 months.
Had a "nervous breakdown" after four days of combat in France.
COURT MARTIAL: None.
MARITAL HISTORY: Single. Denies ever having had intercourse.
SOCIAL DISEASES: Denied.
ALCOHOLISM: Denied.
DRUG ADDICTION: Denied.
CIVILIAN ARRESTS: Denied.
INTELLIGENCE: No formal psychometric test was done. He seemed
above average in intelligence.
PRESENT ILLNESS: Patient developed a "nervous breakdown" after
four days of combat in France. He had "shaking spells" lasting about a
half hour, three or four times daily for about two weeks. During these
attacks he did not lose consciousness and he did not bite his tongue or injure
141
380 GROUP PSYCHOTHERAPY
himself in any way. He regained control of sphincters. The patient was
nervous and tense and had a gross tremor of the hands which were cold and
moist. He had nightmares of battle-experiences. He said his trouble
began when a shell exploded dose to him. He was blown out of his foxhole
and was unconscious for about a half hour.
PSYCHODRAMA: We acted out scenes from his early life. Up to his
fourteenth year he had "shaking spells". He slept in the same room with
his mother so that she could watch out over him. When she left the room
he developed "convulsions." We also had him relive some scenes in which
he became ill before examinations in school. Finally the scene in which he
was blown out of his foxhole was reenacted. After he had regained con-
sciousness he had walked for about forty minutes to rejoin his outfit. When
he reached his company he developed a series of attacks.
All these scenes followed each other in rapid sequence which accentu-
ated the similarity in their pattern. The subconscious mechanism of
his seizures was explained to the patient.
DIAGNOSIS: Psychoneurosis, hysteria.
PROGRESS: No seizures while in the hospital.
DISPOSITION: Evacuated to a general hospital.
CASE I
ORGANIZATION: Quartermaster service company.
PLACE OF BIRTH: Small town in South Carolina.
AGE: 23.
RACE: Negro.
OCCUPATION OF FATHER: Farmer.
FAMILY HISTORY: Negative.
HOME LIFE: Normal.
EDUCATION: Repeated the third grade, finished the fifth grade,
Quit school at 15 to work on the farm.
CIVILIAN OCCUPATION: Foundry worker, farm hand, bricklayer.
DATE OF INDUCTION: March 11, 1943.
ARMY LIFE: Private, worked as a bricklayer. In the E. T. 0. eight
months but never in combat.
COURT MARTIAL: Denied.
MARITAL HISTORY: Single. Denies intercourse or homosexuality.
SOCIAL DISEASES: Denied
142
PSYCHODRAMATIC METHODS 381
ALCOHOLISM: Denied.
DRUG ADDICTION: Denied.
CIVILIAN ARRESTS: Denied.
KENT EGY TEST: IQ 56. MA 8. Moron level.
PRESENT ILLNESS: Patient was sent to the hospital because he re-
fused all social contacts and preferred solitude; stole little articles of no
real value; refused to keep himself or his equipment clean and presenta-
ble; and he hoarded such worthless items as empty bottles, in his
barracks bag.
In our preliminary interview we learned that he had visual and audi-
tory hallucinations of a religious nature.
PSYCHODRAMA: The patient was placed on a couch, and he was
told to imagine he was in bed, having one of his usual visions before falling
asleep. It was not difficult to induce him to act,
He sat up, rubbed his eyes, looked up with a rapt expression and said,
"I see a white figure beside me, there is a star above his head; he wears a
white robe; his arms are outstretched. There is blood on his hands." We
asked him to demonstrate what this vision looked like. He got up on a
chair, stretched out his arms and said, "There is blood on my hands. It is
from the nails."
In another scene we tried to reproduce some of the voices which he
used to hear. They were of a religious nature, and one would say, "Pray
before it is too late." An auxiliary ego repeated the phrase to the patient
first in a normal conversational voice. The patient corrected us, saying that
the voice really was a whisper. The auxiliary ego reduced the volume of his
voice, but the patient was still dissatisfied. On listening to him again, we
discovered that his voice had a Southern accent. When the auxiliary ego
reproduced this accent, the patient was satisfied.
This case was particularly interesting because of the ease with which
we were able to conduct a psychodramatic session with the patient, even
though he was a far advanced schizophrenic and his mental age was only
eight.
DIAGNOSIS: Dementia praecox, unclassified.
PROGRESS: Unimproved*
DISPOSITION: Evacuated to a general hospital.
143
382 GROUP PSYCHOTHERAPY
CASEJ
BRANCH OF SERVICE: Military police.
PLACE OF BIRTH: Chicago, Illinois.
AGE: 23.
OCCUPATION OF FATHER: Storekeeper.
HOME LIFE: Normal.
EDUCATION: Finished high school and was a good student. Never
cared much for social activities, spending most of his time reading.
CIVILIAN OCCUPATION: Office worker.
DATE OF INDUCTION: January 11, 1942.
ARMY LIFE: In E, T. 0. with the military police four months. Pri-
vate.
MARITAL HISTORY: Single. Patient states that he never had sexual
intercourse.
SOCIAL DISEASES: Denied.
ALCOHOLISM: Denied.
DRUG ADDICTION: Denied.
CIVILIAN ARRESTS: Denied.
KENT EGY TEST: IQ 100 plus, MA 14 plus. Average intelligence.
PRESENT ILLNESS: Patient states that in recent weeks people have
been looking at him in a peculiar way, so much so that he is embarrassed to
go out, and tries to get assignments in his company area to avoid the staring
of strangers. He believes they are making remarks about his changing into a
woman. He thinks that his voice, gait, face and entire body are gradually
changing. Because he looks feminine, his steel helmet looks out of place on
him and he thinks that everyone is making fun of him and saying how
funny he looks in a steel helmet.
PSYCHODRAMA: A number of scenes were improvised in which this
feeling of reference was acted out. He was forced to walk through the office
wearing a steel helmet, in the presence of several people. He walked up and
down, as if he were on a street. Everyone pointed at him, making loud
remarks, such as, "Doesn't he look funny wearing a steel helmet?" and
"He is changing into a woman!" This was kept up for some time. He ad-
mitted that this was just how he felt, but he was amused at the same time.
We then continued to act out his fears reducing them to absurdity. We
improvised several scenes from Thorne Smith's book, Turnabout, in which a
man turns into a woman and has a baby. The patient had to go to the
doctor, played by an auxiliary ego, and explain that he thought he was
144
PSYCHODRAMATIC METHODS 383
pregnant. All this time he was laughing at the absurdity of the whole
procedure and of his fears.
Then we started a program of training to give him assurance, to talk
with a deep masculine voice and to walk with a vigorous, manly gait.
DIAGNOSIS: Dementia praecox, paranoid type.
PROGRESS: Improved,
DISPOSITION: Evacuated to a general hospital.
AUDIENCE TREATMENT
The Treatment was given in front of other patients, 10-12, suffering from
related mental syndromes. The action on the stage was always followed up
by analysis and discussion with the members of the audience (audience
catharsis). It appears to the author as the most deep reaching and most
effective form of group psychotherapy.
CONCLUSION
The psychodrama is a new form of psychotherapy which has been used
here for the first time in an army evacuation hospital.
It is a valuable new tool, easy to apply and with unlimited possibilities.
Ten cases treated by this technique ar^presented here. Because of the short
stay of the patients in our hospital and because of the impossibility of a
follow up in a theater of operations, we do not consider a statistical evalu-
ation of the results of the psychodrama to be justified at the present time.
We hose to
how our method proved itself under the different conditions
which we shall encounter.
BIBLIOGRAPHY
1. Brenman, Margaret, Ph.D., and Gill, Merton M., M.D., "Hypnotherapy."
New York: Josiah Macy Jr. Foundation, 1944.
2. Grinker, R. R., and Spiegel, J. P., "War Neuroses in North Africa." The
Tunisian Campaign (January-May, 1943. New York: Josiah Macy
Jr. Foundation, 1943.
3. Jenness, A,, and Wible, C. L., "Respiration and Heart Action in Sleep and
Hypnosis," Journal of General Psychology, 16, 197-222, 1937.
4. Moreno, J. L., "Psychodramatic Shod Therapy," Sociometry, VoL II,
No. 1, 1939.
5. - . "Psychodramatic Treatment of Psychoses," Vol. HI, No. 2,
1940.
6. - . "Psychodrama," Collected Papers. New York: Beacon
House, 1945.
145
PSYCHODRAMATIC TECHNIQUES AS A TEACHING DEVICE IN
AN ACCELERATED COURSE FOR WORKERS WITH
NEUROPSYCHIATRIC PATIENTS
BY
MARGARET HAGAN
Director of Training
AND
EDITH WRIGHT
Psychodramatist, American Red Cross
St. Elizabeths Hospital, Washington, D. C.
The Surgeon General's Office of the Army requested the American
National Red Cross to supply one psychiatric social worker for every fifty
neuropsychiatric casualties in Army -hospitals. The Red Cross was unable
to do this because of overall shortages in the field, but offered to heighten
its recruitment of psychiatric social workers and to add to its considerable
number of workers already on its hospital staffs, a large number of indoc-
trinated hospital workers/ to work under its experienced psychiatric social
work supervisors in Army hospitals. This plan was accepted by the Surgeon
General's Office,
It was agreed that these hospital workers would be college graduates
with two years of work experience; that they should have the usual orienta-
tion course in general Red Cross philosophy, policies and procedures; and
that in addition they would receive specific orientation which would enable
tttem to give service to neuropsychiatric patients.
To implement this agreement the American Red Cross, under the
auspices of the Staff Development Section, established a course of one
month's duration at St. Elizabeths Hospital in Washington, D. C. ; in April
1945- The staff consists of a Director, a training Supervisor and two
volunteer assistants. Other specialized Red Cross personnel are utilized as
indicated. Experienced psychiatrists on the staff at St. Elizabeths Hospital
give the lectures and clinics and other psychiatrically trained specialists are
available for supplementary lectures and demonstrations.
From the beginning care was taken to present the students with a
balanced curriculum of theoretical, clinical and practical work. Attention
was given to the utilization of rapid training devices such as audio-visual
aids, made available by the U. S. Navy. Time was also allotted in the
146
384
PSYCHODRAMATIC METHODS 385
curriculum for the use of psychodrama as a teaching technique. This paper
is about our use of this instrument as a training device.
Each Saturday morning throughout the course the students and their
instructors assemble for a three hour period in the Theatre for Psychodrama,
They have been prepared for the experience in a onTBotr-kLlmc m which
are Ascribed Differentiation is made between the objeo
tives in the use^f^psj^iQdrama as a treatment process for patients and as
a trainii^-methSiriorstudents, preparing to work with patients.
The psydodramatic^l^foi^^ who
atist and one auxiliary ego, a well trained
\ f j * i j_
Itric- corpsmaai of 'the U. S. Navyf*whose longiamiUarity^wiSi
neuropsydaatiif. patifmts makes him able to enact with versatility patients'
roles in varying diagnostic categories. JiLadditipn, other auxiliary egos are
present whose work at the hospital has enabled them to fulfill realistic
rotes as nurses, doctors, 'womeirygtiSiS'^nd relatives of patients. Afeorder
to give the students an experience in the supervisory relationship, a super-
visor from the Red Cross staff is present as an auxiliary ego. After some
experimentation, we found that the students themselves in this trainmg-$itua-
tion~ifflti&~~not serve afTEu^ilwiet, Out LeijiflftaHy^s^
personnel such as we have described was essential. *
In our experience the warming up process for students and auxiliary
egos is accomplished more easily when the locale and situation is lifted
from the hospital and Red Cross setting and placed firmly in some life
situation such as an overcrowded seaside summer hotel during a weekend,
when there is pressure for rooms and service by the many guesfe. This
device frees the students from self-consciousness to some degree and gets
all of them, as well as the auxiliaries, on tfye stage at one time or another.
It also enables the student to create a role, project and conclude it.
Following this there is a noticeable lessening of tension, a loosening up
in which there is free discussion, criticism, questions and laughter. Then
and only then are we ready to work on the business of training in the art
of the interview, which has brought us together. This is a typical situation:
Mrs. Gerard, an auxiliary ego, the wife of a 30 year old Navy man has
arrived unexpectedly at the hospital and is greeted by the Red Cross volun-
teer in the lobby of the Male Receiving Building. The Gray Lady notifies
the husband's ward by telephone and finds that he is unwilling to have
his wife come up. The volunteer receptionist then calls the appropriate Red
Cross supervisor in this emergency.
386 GROUP PSYCHOTHERAPY
The supervisor, an auxiliary ego, gives the case to a new hospital
worker, who after asking her supervisor all the questions she wants, pro-
ceeds through the lobby and to the ward for her first interview with the
patient who is still pretty sick and a recent arrival at St. Elizabeths.
She greets the ward nurse in her office, introduces herself, asks for and
reads the meagre ward notes and then interviews the new patient who as
an auxiliary ego carries out his role of frigid politeness with a suggestion
of insolence, disclaims need of help and voices surprise at his wife's arrival,
suspicion of her infidelity and neglect of his children and reiterates his
unwillingness to see her. The hospital worker concludes the interview, the
scene is cut.
Three volunteers (hospital worker students) are withdrawn from the
audience so that they do not see one another's interviews, and one at a
time successively interview the waiting wife in a corner of the lobby. This
standard situation gives opportunity for these workers to try out their
knowledge of human behavior, of Red Cross function and of specific hospital
policies.
The wife's role as auxiliary ego is that of a skinny, earnest, courageous,
hard working little woman with two children who is using her vacation
time for this visit with her husband, whom she has not seen in two years.
As the story unfolds one finds her working for a tailor, Mr. Levine, whose
cousin has a day school and is caring for her children. Mr. Levine has
helped her buy a sewing machine, has advanced money on her salary for
this trip. The wife throughout the interview persists in her desire to see
her husband, cannot understand nor accept his unwillingness to see her,
and reiterates her theme about her vacation time, the expense and her dis-
appointment. She is a very determined lady. The student carries and con-
dudes the interview with varying degrees of skill.
We are unable within the limitations of this single article to discuss in
detail the resolution of this provocative situation by the three workers.
One may concentrate on the practical details of making Mrs. Gerard's visit
comfortable; another may hastily go in search of a physician in order that
he meet Mrs. Gerard's obvious need for explanation and reassurance; an-
other may telephone her supervisor for suggestions or help or may undertake
aa explanation herself. The audience meanwhile may wonder if there is
any basis in reality for Mr. Gerard's feeling about Ms wife's unfaithfulness
and negkct of his children? In discussion these points and many others
come up and are examined freely. A transcript of this segment of a session
148
PSYCHODRAMATIC METHODS 387
would be illuminating here; but we are not able to furnish it in this paper,
nor can we do more than suggest a few other useful situations used in
training sessions. Such as:
1. A twenty-eight year old Army nurse with a depression has not
written home. An urgent letter is received by the Field Director at the
hospital from the Red Cross Chapter saying that the nurse's mother is
acutely upset because she hasn't had a letter in her daughter's handwriting.
The student worker goes to the ward to see the patient in question. Later
on the stage she dictates a letter to the Chapter. At times this simple
situation has led to an interview with the medical officer and the supervisor.
2. A hypomanic patient, who has written his wife of his promotion
from Storekeeper Second Class to Lt Commander and that he is now in
love with a nurse, is seen by the hospital worker in an initial interview.
3. The aggressive wife of an officer arrives, demands to see the Super-
intendent rather than the ward medical officer; says that her husband isn't
sick but in one of his moods from which she can easily snatch him; wants
him discharged from the hospital and is unwilling to give a history to the
worker.
Weeping mothers, inarticulate fathers, fond aunts, understanding but
anxious wives are in the familiar galaxy as are psychopaths, psychoneurotics,
and the catatonic, who on interview is mute. Harassed nurses, busy doctors,
volunteers and colleagues are encountered on the stage in the logical, spon-
taneous use of resources by the student.
Frankly, the use of this technique in training was first visualized by
us merely as an aid to teaching the art of the interview. We believe, how-
ever, after three months' experience in its use with these and other students
that it provides a flexible ,and incisive m^ans of teachingjin the round.
Particularly does the student feeUhe necessity f& handliii
keeping her head and managing her emotions in the midst of her new world
with its wartime tensions and confusion. The temptations to lean too heavily
or not enough; to become over-identified with a patient or relative; to resort
to speech .making with an exciting new vocabulary, are ever present, as is
the opportunity to hurt, to resort to a half-truth, to meet hostility with
hostility.
The impact of this spontaneous realistic drama upon the audience
"packs" in the vernacular a "wallop" because of its emotional validity.
Instinctive use of old but newly heightened skills by the students, natural
grace and flair in the field of human behavior is quickly detected and praised
149
388 GROUP PSYCHOTHERAPY
by the audience. Poor handling of the problems; failure to pick up clues;
inability to use silences are noted and analyzed by the students.
We still consider ourselves in the experimental stage, but tentative
conclusions are that:
1. The use of psychodrama as a teaching device for students who
must quickly learn some of the specifics of dealing with exaggerated, height-
ened interpersonal relationships provides (a) a non-didactic method (b) by
which skills are acquired and (c) without damage to a patient and (d)
where recording of a private interview does not intervene to confuse the
picture,
2. The auxiliary egos used in training must be masters of their own
technical fields in contrast to those used in work with patients.
3. The psychodramatic situations used should be graded as to com-
plexity and correlated with the progress of the students' didactic, theoretical
and clinical studies.
I. It seems to prepare the student for her practical work with patients
on the wards of the hospital and the students themselves often suggest
parallel situations which they are anticipating or experiencing.
5. Because psych^rama^rg^nts situationsJaJhe round which are
worked out to condusion^ iL^ixea .the, student ..experience in mterpersonal
relatioDships-which* helps- her-as-saelljgjier instructors to assay, jt^,depyee
of "integration" she has achieved at any given point. By this we mean in
plain JEnglisJf that in this one month's course the student has' ttf 'get into
essentials, the fundamentals* "of - famna
its deviations. This new knowledge must be integrated, must become a part
of Tierscrtiat her own mtfp0^on^r^ff6nf 'wffh "those she is trying to
help flow with natural, warm -hearted -wisdom .from. ,& person of firmness
and integrity. The very nature of psychodramatic work exploits this
necessity.
" We might add that the accent is definitely on the use the student makes
of her new learning through the instrument of her own personality.
Its realistic, spontaneous methodology discourages psychiatric jargon,
The students themselves make written evaluations at the end of the
total course, in which they criticize and suggest what ha^ and has not been
helpful In the opinion of all students so far^sjrchodrama is^the best teach-
jgsJfirhniflUfiAoy have -ever encountered. They add that* at times it makes
them acutely uncomfortable since it puts them on the spot, but aU are
agreed we should continue its use.
ISO
SPONTANEITY TRAINING OF THE FEEBLE-MINDED
THEODOKE R. SAKBIN
Los Angeles
The following account describes the application of Moreno's spontaneity
training to a group of feeble-minded boys and girls in an institutional milieu.
Only preliminary observations are given inasmuch as the experiment was dis-
continued when the author resigned from the institution. Because the be-
ginnings of the experiments were so instructive and changed the role-capaci-
ties of the patients, I am presenting these preliminary observations here so
that it might stimulate others (who have experimental material at hand)
to continue a phase of social-psychological and sociometric research which
has interesting possibilities.
Prior to the inauguration of the administration which gave assent to
this experimental program, the Lincoln State School and Colony in Illinois
had been operating on the silent assumption that the institution was a form
of correctional or penal institution. Discipline was the chief concern of
most of the personnel. "The patients have to be kept in line or they will
take advantage of you."
The reaction to this form of restrictive and repressive frustration was
in the form of occasional aggressive acts and attempts at escape, but more
frequently the repression of spontaneity on the part of the patients. The
institution sponsored stereotyped behavior. If one followed the rules, stayed
in line, did not speak to girls, did not react to a drunken attendant's un-
couth or obscene language, in short, if one behaved like an automaton, he
was considered a good boy. It can be said that the patients were forced
to act like feeble-minded people are supposed to act stupid, without self-
expression, without spontaneity. It was little wonder, then, that when an
occasional boy or girl was paroled for outside work, the adjustment was
too difficult and the parolee was returned to the School.
The assumption behind the author's attempt at social re-education was
simply that feeble-minded people (more correctly, morons) are not obliged
to be stupid. The group selected for study was made up of late adolescents
and early adults. The youngest was 16, the oldest, 28. Most were in
their early twenties. The IQ's ranged from 57 to 84 ; the mean being 61.
Most had been in the institution at least seven years. The size of the
group fluctuated: most of the time 8 to 10 girls and 6 to 12 boys were
present.
1S1
389
390 GROUP PSYCHOTHERAPY
The experiment really began several months before any formal action
was taken. The author had earlier adopted an attitude of acceptance toward
the patients. That is to say, they were treated as they expected human beings
to be treated: with dignity, fairness, and without condescension. These
expectations may have come from the radio, the movies, the schools, or
their interactions with the outside world prior to entering the institution,
but they did not come from interactions with most of the politically-ap-
pointed personnel.
The attitude of acceptance was implemented by overlooking many con-
crete acts which would have resulted in disciplinary action, by drinking soft-
drinks in the commissary with the boys, by giving them virtual freedom
of my apartment, etc. The disparity between the traditional treatment
based on out-moded penal theories and the acceptance accorded by the
author was soon perceived.
The first problem confronted by the author in the beginning of the ex-
periment centered around the fact that these boys and girls were not ac-
customed to working or playing together. For many years, the administra-
tion seemed to have been chiefly concerned with preventing pregnancies.
This was carried to such an extreme that if a boy or girl was discovered
forking to a patient of the opposite sex or passing notes, the most severe
form of disciplinary action was invoked. Even the weekly dances, which were
attended by all the older boys and girls, did not allow mixed dancing. The
girls would dance with each other and the boys likewise. (Parenthetically,
homosexuality was frequently practiced and severely punished yet danc-
ing between members of the same sex was supported and encouraged.)
Against this background, the experimenter organized and carried out
the initial stages of a program designed to introduce more adequate social
responses into their meager repertory of behavior. During the first few
meetings, the girls would sit on one side of the room, the boys on the other.
Giggling, embarrassment, and other actions disturbed the smooth workings
of our program. After the first week, however, the strain of heterosexual
contact was overcome and there was a freer interplay of conversation be-
tween the boys and girls.
In order to profit from their previous experiences, we began by "having
a play." Prior to this time, in the summer of each year a cast was selected
for a Christmas play and each character was drilled and drilled into learn-
ing lines which were finally intoned in characteristically rigid performances.
152
PSYCHODRAMATIC METHODS 391
One of the group selected a play from the library. It was a sophisticated
Broadway success of several years ago. Because of its length, we decided
to assign parts for the first act. However, instead of giving each person a
"part" to memorize, the whole play was read by the experimenter with an
interpretation. The next step was fa: each of the characters to take the role
assigned him without a script. The. experimenter took the role of a stage
director here indicating to each of the 10 characters who he was, what he
was supposed to be doing, why, and how. Each actor was encouraged to
use his own words.
By the artifice of "having a play" the group was warmed-up to the task
of taking roles in spontaneous fashion. Now the play was discarded and the
purpose of the psychodrama explained in simple terms. The subjects were
told that in order for them to be ready to accept the responsibilities of the
outside world if and when paroled, they would have to be prepared for the
adjustments demanded by non-institutional setting. It should be added that
these patients were not entirely ignorant of the outside world only one of
the patients had spent his entire 26 years in the institution, the others
for the most part had come to the institution during adolescence. In addi-
tion, the weekly motion pictures and the radio acquainted them with some
of the behavior responses characteristic of the world outside.
At this point, simple situations were outlined and volunteers from the
group took roles. The delivery boy, the iceman, the milkman, the maid,
the gardener, the grocer's helper, the farm boy, the child nurse, these and
other roles were assigned and acted out. The spectators, Le., members of
the group not on the stage, would actively criticize discrepancies between
the actions of the actor and the demands of the role. The procedure was
a direct contravention of methods usually taken in dealing with mental
deficients. Instead of the laborious and dull methods of repetition depend-
ing on the old Thorndikean Law of Exercise the subject was encouraged
to be spontaneous, to act the role in any way he saw fit. In this part of the
experiment, the giggling and razzing disappeared entirely*
After four weeks (three mornings a week), one of the girls asked if
they could do a family scene. The experimenter approved. She adjourned
to the adjacent hall with four other girls and two of the younger boys. After
about 10 minutes, they returned and seated themselves around a large table
(our only prop). The two boys were seated somewhat apart from the girls
apparently engrossed in an imaginary game of checkers. The girl who
153
392 GROUP PSYCHOTHERAPY
had suggested the action was the mother, the others were her children.
Following is a record of what happened:
FLORENCE (the mother) : Jane go to the store and get some milk and a loaf
o' bread. It's near supper time and Paw'll be comin' home.
JANE: Aw! Send somebody else! I'm tired.
FLORENCE: Gripes sake! You ain't done a thing all day and you're tired.
Get goin!
JANE: Why aincha askin' one o' them lazy boys. They ain't doin' nothin'
but playin' checkers.
FLORENCE: You get goin' or I'll bat your ears in. (Exit Jane, grumbling)
SUSIE: I wonder how Paw will be when he gits home. If he hits me agin
I'm goin' to run away.
MARY: I betcha he ain't comin' home tonight. I betcha he's gettin' drunk
somewhere.
FLORENCE: Don't talk about your Paw thataway.
JIM: If he lays his hands on me again, I'll clip him one.
FLORENCE: Shut up! or I'll clip you. (To Mary) Go set the table. I'll
mash the potatoes. (Business of setting table and mashing potatoes.)
The dialog is here interrupted to interpose an observation. The psycho-
drama does not easily lend itself to literary description. This situation is
not an uncommon one among the families of committed feeble-minded pa-
tients. Broken homes due to alcoholism frequently bring dependent children
into the juvenile or local courts, and commitment seems the easiest way of
handling a vexing social problem. These girls acted the roles so convincingly
that visitors at this session questioned that it was not rehearsed many times.
What they were doing was reliving a scene which in its fundamentals was a
part of their own experience.
To continue the psychodramatic record:
Jane returns to the stage. She places a quart of milk on the table. (She
had actually gone to the neighboring building and procured a quart of
milk.) When are we gonna eat?
FLORENCE: Soon as Paw gits here.
(At this point, Fred, one of the older patients in the audience, spon-
taneously rose from his seat and walked up to the action. Although he was
not in the preparation at all, the actors were so warmed up that his intru-
sion did not interfere with the smooth functioning of the psychodrama.)
FRED (to Florence) : Hiya Maw, Supper ready?
1S4
PSYCHODRA1V&TIC METHODS 393
FLORENCE (Without a moment's hesitation): It's about time. Where ya
been? Ya ain't been drinking, have yah?
FRED: Nope. (Then to two boys who are still playing checkers). Come on
boys, time to eat.
(Here a moment's hesitation. Then Fred speaks again.)
FRED: Maw, I got sumpin' for yuh. (He takes a piece of crumpled news-
paper from his pocket.)
FLORENCE: Five dollars! What'll we buy with it?
The action continued with an animated interchange of ideas as to
what five dollars would buy.
This is reproduced here to demonstrate that even feeble-minded patients
who have been forced into stereotyped roles can be warmed up to role-
taking. Naturally, the variety of roles will be less than with people of
normal intelligence. Of special significance is the fact that Fred, a non-
participant in the preparation for the action, saw an opportunity to pky
the role of the father and took it. Furthermore, the other players interacted
with him in spontaneous fashion without any overt disturbance.
This anecdote is one of many which took place during a two-months
period. Although no attempts were made to introduce controls or to refine
the experimental procedures, the author is convinced that such methods
will reduce our institutional populations.
The foregoing observations suggest this hypothesis: morons can be
stimulated to react intelligently to social situations through the use of psy-
chodramatic and spontaneity training methods.
Testing and verification of this hypothesis would help solve not only
the social and economic aspects of feeble-mindedness, but would contribute
to a better theoretical formulation as to the social psychological nature of
intelligent and non-intelligent behavior.
155
PATIENTS AS THERAPEUTIC AGENTS IN A MENTAL HOSPITAL
GERHABD SCHAUER, M.D.
* Everyday experience teaches us that people function better in one group,
worse in another.
Everyday observation in mental institutions teaches that the same
thing is true among mental patients. We can safely say that one group
in certain situations has a beneficial effect upon one individual's well being
and functioning, whereas another group does not. And we can call this
beneficial effect, which the individual derives from his inter-action with
other group members "therapeutic," because he is "helped" or "served"
by the group in attaining greater well-being, personality development and
greater freedom of expression of his particular kind of spontaneity than
he would in a different social environment.
Interesting studies of this effect have been made by Moreno and co-
workers, in placing patients into the social group and social situation in
which they are able to function most effectively, i.e. where inter-action
between individual and group in a social situation is of maximum therapeutic
efficiency. The application of this principle has been called assignment
therapy.
Just as in medical therapy a system of therapeutic units has been
worked out, by which drugs like digitalis or insulin can be given to a patient
with exact knowledge of their effects, a method would be desirable, by
means of which the beneficial or detrimental effects taking place between
the members of a group with regard to some social situation could be simi-
larly evaluated.
During a recent stay at a small psychiatric sanatorium* an attempt
was made to evaluate the beneficial and detrimental inter-actions taking
place in the hospital community by means of sociometric testing. A number
of sample situations were selected for which the individual group members,
patients as well as staff, were interviewed with regard to greatest and least
preference for each other. The total participation was computed and each
group member was scored according to several criteria. The test results
reflected the social hierarchy in the community. The majority of choices
went to a few individuals who by the nature of their occupation, were in key
*Beacon Hifl, Beacon, N. Y.
156
394
PSYCHODRAMATIC METHODS 395
positions in the community. The fact that they actually received the greater
part of choices indicates that their personalities qualified them to assume
key positions (nurses, assistants). It was further found that these key indi-
viduals extended their preferences with regard to the sample situations
largely to the medical director, who, besides being chosen directly, became
the recipient of many indirect choices. "The amount of direct influence
the leader of the group exerted, was minimal, compared with the amount
of influence he exerted actually, mostly via indirect channels." (Aristo-tele).
In evaluating the contribution made by the patients toward the equi-
librium and welfare of the group, sociometric testing showed this to be
approximately 2Q% of the total "therapeutic energy," determined by this
method. By observation it was found that several of the patients assumed
therapeutic functions for each other. The figures obtained suggested that
the contribution of the patients to the adjustment and welfare of the group
to the hospital situation is not negligible, if compared to the contribution
of the staff, especially as the latter has been so far regarded as the sole
carrier of therapeutic functions. In larger institutions, with greater numer-
ical discrepancy between staff and patients, the contribution of the patients
towards the stability of the hospital community should be much greater.
However this would have to be submitted to actual sociometric testing, with
its accompanying activizing effects upon the community.
157
DRAMA THERAPY
LEWIS BARBATO, MAJOR, M.C.
Neuropsychiatric Service, Fitzsimons General Hospital, Denver, Colorado
The drama therapy at Fitzsimons General Hospital is conducted under
the supervision and direction of the Chief of the Neuropsychiatric Service,
who works in close contact with the "drama team."* This team consists of
a dramatic director who is an enlisted man having an M,A. degree in dra-
matics from Kansas State College and Washington University, an assistant
who is a civilian nurse with considerable experience on a military psychi-
atric ward and as an amateur actress, and a stenographer. Each of these
individuals has received considerable orientation in dinical psychiatry and
semantics, and are now taking the courses in psychodrama (1) given by
Dr. Moreno and his assistants at Denver University.
At present, drama therapy is being used at Fitzsimons only with closed
ward patients having both psychotic and psychoneurotic diagnoses. The
patients are selected and the treatment is prescribed by the psychiatrist.
Various techniques are employed depending upon the nature of the
case and the purpose desired.
(1) One type of approach makes use of ventilation of fixed emotion-
alized attitudes that are sources of tension and conflict, followed by an
attempt at reconstruction and re-orientation.
In this method, the patient, or group of patients, is presented a situa-
tion or topic for discussion about which certain rigid emotionalized attitudes
are held. With the aid of the director and a supporting character, the patient
is led to verbalize these attitudes by a process of "ad libbing." This ma-
terial is recorded by the stenographer and transcribed. It is then edited
by deleting irrelevant statements without changing the wording. After this
is completed, each patient reads and acts out his own script. At this point
an electrical transcription is made of the performance. At a later date, each
patient listens individually to his recording and is asked to discuss the ideas
and emotions he previously expressed. , This is also recorded. It is followed
by a psychotherapeutic interview with the psychiatrist. .
*In this phase of our treatment program, I am indebted to T /5 Orvis Grout,
Med Det., drama director; Miss Lee Zanon, R.N., assistant; and Miss Jessie Greensley,
stenographer, who compose the "drama team."
158
396
PSYCHODRAMATIC METHODS 397
(2) In another technique, the patient, with the aid of supporting
characters, re-enacts various emotionally traumatic episodes encountered
during his military and combat experience. He is required to re-enact these
experiences many times until, through a process of desensitization, they no
longer serve as foci of anxiety.
The material in this approach may be furnished by the psychiatrist
from his study of the patient with or without pentothal sodium, or obtained
from the patient during the development of the drama situation. In either
case, the procedure is one of catharsis and desensitization.
(3) In a third technique, the patient is given certain emotional
situations to act out on the stage. The situation may be an immediate one
facing the patient, or any one of several likely to be experienced upon
return to civilian life; such as, returning to wife and home, answering in-
quisitive friends concerning experiences and reasons for discharge, finding
a job, or going back to school, etc.
In securing the material for this type of drama situation, the patient is
given a setting or situation suggested by his particular problem. He is then
required to project himself into it and to behave or react as if he were
encountering a similar situation in "real life." This extemporaneous ma-
terial is recorded by the stenographer and transcribed. With the aid of
this script material a second drama session is held in which the patient
is "coached" to make proper and adequate adjustment reactions.
This technique actually represents a variation of the second one de-
scribed above. In that approach, the patient becomes desensitized to past
emotionally traumatic episodes; whereas in this one, he becomes desensi-
tized to anxiety-laden anticipated situations. By this process 'of "learning
by dojtag," anxiety of the future is lessened and confidence is regained.
(4) In a fourth approach, utilization is made of "opposites." Here, an
aggressive patient is given a submissive role or vice versa; or an enlisted
man with considerable hostility towards officers is given an officer's role.
In the former situation, the patient acquires experience in inhibiting or
extroverting, as the case may be; in the latter, he gains insight and under-
standing and experiences an amelioration of his hostility. This technique is
also followed by a psychotherapeutic interview with the psychiatrist when
indicated.
In addition to these uses of the drama as an aid in therapy, it is also
being used in teaching student nurses how to handle various psychiatric
159
398 GROUP PSYCHOTHERAPY
situations and problems. For example, the student is presented with a
patient who refuses to eat (played by a student) and is required to show
by acting out, the proper method of dealing with the problem. In another
drama situation, the student is confronted with a visiting relative who asks
many questions and expresses doubts and fears concerning the patient's
illness. The student is expected to act out the proper handling of the prob-
lem. These and many other problem situations in psychiatric nursing are
enacted by the students with the view that they learn best by doing.
There are many ways in which the stage can be used effectively for
therapeutic purposes. For us, the methods described are simple, effective,
and serve a useful purpose.
BIBLIOGRAPHY
I, Moreno, J. L, "Psychodrama and the Psychopathology of Interpersonal
Relations," Sodometry, Vol. I, No. 1, 1937; see also Psychodrama
Monograph, No. 16, Beacon House, New York.
160
SOCIODRAMA
A SOCIODRAMATIC AUDIENCE TEST
ZERKA TOEMAN
Psychodramatic Institute, New York City
INTRODUCTION
In an earlier paper the author pointed out the value of psychodramatic
methods for educating and adjusting the draftee to the role of the soldier
and alleviating strains of the hangovers of roles in civilian life. It is clear
that such training need not be limited to training for the military, but
that in reverse, it may be employed in the readjustment to civilian life.
While considering the problems of the returnee, it is pertinent to consider
equally the responsibility of those to whom the men return. Much is heard
concerning the rehabilitation of our fighting men but little is done about
the rehabilitation of the families they left behind. Their attitudes towards
occupation, fraternization, re-education of former enemies, relations with
friendly nations, relations to minority groups at home, employment for
veterans, to mention but a few larger categories, are of primary importance
in a sociodramatic program of rehabilitation.
In psychodrama we deal with collective as well as private ideologies;
the method dealing with the former has become known as "Sociodrama."
It is, of course, not possible to separate the soldier from a soldier, the son
from a son, they are the product of influences of both a private and collective
nature. However, there are certain aspects of their performance which are
shared by all other soldiers, all other sons. It is these collective aspects
of their roles with which we deal in sociodrama (7).
We propose to bring forth in this paper some of the highlights of
audience tests made at the Psychodramatic Institute in New York and
Beacon with the relatives and friends of fighting men.
CATEGORIES OF STANDARD SITUATIONS
Three main categories of standard situations have been used in the
past at the Institute. Moreno has called them the Three Situation Set:
Intimate or Family Situation, Work Situation and Community Situation.
The set proved useful in analyzing the range of representative roles in which
161
399
400 GROUP PSYCHOTHERAPY
subjects function. In a recent session Moreno (9) suggested that in dealing
with audiences requiring a more refined analysis of role-interaction, the
Three Situation Set may be replaced by a Seven Situation Set: Government
vs. Citizen, Husband vs. Wife, Parent vs. Child, Sibling vs. Sibling, Em-
ployer vs. Employee, Stranger vs. Native. According to Confucius there
were five basic human relations: Ruler vs. Subject, Husband vs. Wife,
Father vs. Mother, Older Brother vs. Younger Brother, and finally Father
vs. Son. The two situations added above did not have any significance in
the Chinese culture of Confucius' time those of the Employer vs. the
Employee, and the Stranger vs. the Native.
We will illustrate here how the polarity, Role of the Stranger vs. Role
of the Native, can be used in the testing of audiences. In this category
may fall many groups, for instance ethnic minorities, enemies, refugees, but
also in certain situations, our own veterans. Following the pattern of role
analysis elsewhere described (11), we used as the subjects of our investiga-
tion people who were facing an adjustment problem which they wished to
have treated on the stage. Since it is impossible to test every member of the
audience representatives are picked, but such representatives who themselves
have a similar problem, to remove the elements of fiction which might other-
wise so easily creep into sociodramatic sessions. The problem should always
be as concrete as possible, the Negro-White conflict, the G J. vs. the Civilian,
etc., using certain typical situations in which this conflict is most clearly
demonstrated (1). It has become a rule at the Institute to place on the stage
three representative samples and to let the audience react to them, as soon
as the scenes are ended. A greater number of subjects may be used, but
experience has shown that in general, three are sufficient to allow a cross-
section analysis of the role structure of the audience. Three subjects chosen
at random show, if taken by surprise, widely contrasting enactments of the
same situation. Some of the more popular audience tests are, for example:
Three automobile drivers are given the following instructions You are
driving along a parkway. Although the speed limit is 45 miles per hour,
you are in a hurry to get somewhere. You may be driving too fast. Go
ahead, warm yourself up to driving a car. An auxiliary ego in the role of
a State Trooper is told to stop them and to give each subject a ticket for
speeding. (Subjects are called out one at a time, they do not see anyone
else's performance until they have taken their turn.) The results have
varied from abject subordination on the part of the testee, to bribery of
and lastly, assault on the State Trooper. One subject threatened to drive
162
SOCIODRAMA 401
fast enough to kill himself upon being stopped. Further inquiry disclosed
that he did not know how to drive a car, and this type was entitled "fantasy
driver." He behaved in an irrational, fantastic fashion, out of proportion
to the stimulus offered, much as a mental patient might. Experiments with
many fantasy drivers have shown weird reactions, though not all of them
as extreme as the above mentioned. An audience vote was taken after three
versions had been demonstrated and an analysis of votes made. Another
test dealt with the return of three discharged veterans to their home town.
They were asked how they planned to return, at what time of day or night,
and who would be at home to meet them. I recall that in one case a sub-
ject returned at night, alone, taking his family by surprise. His wife was
at home, tinkering with an electric iron that had broken down. She was
happy to see him and he immediately made himself useful by repairing
her iron. Another returned to his mother and took it easy for at least a
month before attempting to look for a job. A third did not go home, but
settled down in a big city. He had learnt a new trade in the army and
wanted to apply it in civilian life rather than to return to his father's farm,
or else to go back to school and to take advantage of the government's
program in making up for his lack of education. Again, an audience
analysis was made and the votes recorded. Yet another test was made in
which the subjects were all women. The auxiliary ego used in this scene
was a serviceman still in uniform. The subjects were "warmed up" to the
following theme: You are driving along a lonely highway at night. You
are alone and anxious to get home as it is a dark night and quite late.
Go ahead. The auxiliary ego (in the soldier's uniform) was instructed to go
up to the subject with the request to be given a ride to a point up the road,
stating that it was an emergency. On the average, out of a series of three sub-
jects given this test, two did not stop each time to pick up the soldier
although he had campaign ribbons and sundry decorations. Reasons given
for not doing so were: "Well, I was alone and It was at night," <Tm
ashamed to admit it, but I'd be afraid to." "I would if it were day time."
<f One reads such awful stories in the newspapers, I would only do it if
a man were with me." "It was dark and I couldn't tell whether he was a
clean-cut man or not." Among the subjects who stopped to give the soldier a
life one was a "fantasy driver"; the second said that she was too old to worry
about whether it was safe or not, a third stated that her husband was in
the army too, and she'd like to think someone would do the same for him
if need be. Again audience reactions were taken, and the testees who did
163
402 GROUP PSYCHOTHERAPY
find reasons for giving the soldier a ride did not find as large adherence
as those who refused to pick him up.
The following tests presented here were given to nine unselected audi-
ences, using three subjects in all cases. The aim of our investigation was
to determine whether this method, used on many audiences, would enable
us to find what constitutes: (a) a "typical" audience, (b) a "marginal"
audience and (c) a sociopathic or "sociotic" audience. A typical audience
(from the point of view of role configuration) was defined as drawing a
majority of votes in at least 75 per cent of all potential audiences in the
United States, at a time when the test was given. A marginal audience
was defined as drawing a minority of votes in 25 per cent or less, of all
potential audiences in this country. A sociotic audience, the membership of
which are not necessarily mental patients, would show pathological role
structure; according to Moreno's definition* the single individuals may
be normal, their interaction is abnormal,
THE TEST SITUATION
Instructions to the Subjects
Our subjects were mothers of a son in the services whom they were
shortly expecting home. An auxiliary ego represented the son. The situa-
tion was: Your son has returned from Germany about a week ago. Before
he left for the army he was in love with a girl from your home town. They
planned to be married when he returned from overseas. The girl has come
to you today and complained that his affections for her have cooled, she
fears that she has lost him. You are deeply disturbed and want to find
out what has happened to your boy, and why this change has come over
him. Act the way you would toward your own son under similar circum-
stances.
Instructions to the Auxiliary Ego (not heard by the subjects)
Your function is that of the tester. Your performance has to be the
same in the case of each subject. Everyone of these mothers will probably
produce a varying emotional response to the situation. You, however, must
present as much as possible the same stimulus in all cases. You are our instru-
ment of measurement (2,3,4, 6). Remember that you have recently come
home and are discharged from the army. You were engaged to an American
*See Who Shall Survive?, p. 192.
164
SOCIODRAMA 403
girl before leaving for Germany and you planned to marry her. But, during
your stay in Germany you met and fell in love with a German girl whose
father had been a member of the Nazi party. You and this girl are devoted
to each other and have promised to marry. You have not mentioned it to
your family or former fiancee, but you are going to tell your mother now.
Reactions of the Subjects
We are merely indicating some crucial moments in the presentation of
three of the typical mothers. Our first mother reacted as follows, after the
boy had stated his plans:
Mother: But are you sure you love this girl? Does not the fact that her
father was a Nazi make you suspicious of her? Have you given the
matter earnest thought?
Son: I have thought it over very carefully, mother. I don't care what
her father was, I love her. She is just as sweet and lovable as any
other girl and we want to get married. I want to get her over here.
Mother: Well, I don't want to stand in the way of your happiness and
I'm sure no one else in the family will either, if you sincerely be-
lieve you're doing the right thing. But how can you be sure? Per-
haps she is using you just to get out of that country!
Son: Mother, that is not true. She loved me when I was over there, even
before we thought of getting married.
Mother: I can't say I'm not disappointed. After all, we've known Ellen
since she was a little girl The families have known one another so
long, and you were engaged to her. Who's going to tell her?
Son: I'll have to. I'm sure that Ellen will understand, she wouldn't want
me to pretend to her that everything is the same as before.
Mother: It's not going to be easy for any of us, but we'll do our best.
Of course, you're going to live in a home of your own.
Son: Don't worry. Everything will work out alright.
Mother Nwnber Two presented a more receptive picture.
Mother: The important thing is that you love her and that she really
loves you.
Son: Oh, but we do love each other. Why pretend?
Mother: I feel sorry for Ellen, You'd better tell her. She was very
unhappy about you. I can see now why she would be. It's going
to be hard for her, living so dose by.
Son: I'll tell her mother, I'm sure shell understand. You can't fool your
own heart.
165
404 GROUP PSYCHOTHERAPY
Mother: But what da you plan to do about your girl?
Son: I'm going to have her come here. Then well get married.
Mother: Well, we shall be very glad to have her. Of course, shell stay
with us.
Son: Thanks, Mom, I knew you'd understand.
Mother: It will be lonely for her at times, so far away from her own
people, I know that anyone whom you pick for a wife must be a
very fine person, no matter what her political connections are. As
long as she makes you happy we will all be fond of her, too. Well
try to make her feel at home, you can be sure of that.
Mother Number Three was of a different mind.
Mother: But how can you fall in love with a girl like that? I don't under-
stand! Her father and his gang have put thousands of our boys to
death, and murdered other innocent people. What were you fighting
this war for, anyway? How can you call yourself an American and
look a girl like that in the face?
Son: But mother, I love her. What difference does it make what her
father did, or anyone else, for that matter? She is just like any
other sweet, lovable girl and I know she loves me. Don't you think
that's important?
Mother: Ellen loves you too. Are you thinking about her? How do you
suppose she'll feel about this?
Son: I'm sure Ellen will understand. Love is more important than what
anyone thinks.
Mother: Are you planning to go to Germany and live there?
Son: No, I had thought to bring the girl here, so we could be married
at home.
Mother: Bring that girl here? Into my house? Never! I will never
stand for that, and neither will Dad and your brother. Why, think of
it, your brother is going into the army himself this year, how do
you think he'd feel? And Ellen living here in town, too. You must
be out of your mind. I don't understand you at all. You're not
like our boy anymore. The war certainly changed you!
The analysis following the demonstration of the three solutions showed
significant differences in the nine audiences. The questions to which audio-
egos responded were: With whom of the three mothers did you identify
yourself? Why did you pick her? Is it because you are in the same situa-
tion? Do you know someone who is in the same situation? Is any one of the
166
SOCIODRAMA 405
other mothers closer to your own situation? If so, why did you not choose
the one whose problem resembles yours? How did you feel about the son?
Do you think he acted the way a son should have acted towards his mother?
Do you think a soldier should do what he did? Would you behave that way
if you were in his predicament? How do you feel about his action towards
the American girl? If you have such a problem, would seeing these three
different versions of behavior enable you to find a solution of your own?
This test was given soon after the war with Germany had come to an
end. Table 1 was constructed on the basis of answers to the question: with
whom of the three mothers did you identify yourself? It bears out our
estimate of what constitutes a "typical" and a "marginal" audience. All
but Audience No. II and Audience No. VII gave an overwhelmingly superior
TABLE 1
AUDIENCE ANALYSISMOTHER ROLE
(100 persons in each case)
Audience
I
II
III
IV
V
VI
VII
vra
Mother 1
Mother 2
Mother 3
No Vote
11%
29%
55%
5%
19%
53%
25%
3%
15%
36%
47%
2%
31%
22%
41%
16%
9%
15%
67%
9%
13%
14%
65%
8%
23%
49%
24%
4%
16%
38%
40%
6%
100%
100%
100%
100%
100%
100%
100%
100%
vote to the rejecting mother, No. 3. Audience participation was whole-
hearted, as can be seen from the relatively few neutral votes. The largest
number of neutral votes occurred in Audience IV, 16 per cent, and it is
of interest that this is the only case where Mother No. 1 had a larger
following in these audiences than Mother No. 2. Mother No. 1, as we
recall, was the one whose reaction came closer to that of No. 3; she was
not altogether unwilling to accept the German girl, although she foresaw
difficulties. Further questioning of this audience revealed that the large
number of neutral votes was due to the hesitance voters experienced in
casting their vote either totally for or totally against, and this may be why
Mother No. 1 came second for the first time. In Audience No. VI Mother
No. 1 is on almost the same level as Mother No, 2, but Mother No. 3 is
still far ahead of both. Our marginal audiences, No. II and VII showed a
preference for Mother No. 2, the loving type who considered her son's
happiness first and his judgment unfailing. A further study of Table I
shows that Audience VII rated Mother No. 1 and 3 almost equally, with
only a difference of 1 per cent in favor of the latter. This audience gave
167
406 GROUP PSYCHOTHERAPY
a lower score to Mother No. 3 than all the others, nowhere else did this
mother get a minimum of 24 per cent, the next lowest being in our other
marginal audience, No. II, where she received only 25 per cent. It is note-
worthy that the contest between the two extremes, Mother No. 2 and
Mother No. 3 is far more explicit, pointing to how high emotions ran, either
pro or con. Audience No. VIII, for example, finds Mother No. 2 only
2 per cent short of Mother No. 3.
A re-test of this kind at the present time might show a shift in favor
of Mother No. 2, now that mothers are no longer bombarded by wartime
propaganda. However, at that point in time the representative of that great
national, dinical collective, Mother No. 3, was greatly favored, It is of
interest that both Ellen and the German girl were symbols. Neither were
actually known to the mothers but Ellen was automatically preferred and
the German girl rejected, although nothing was brought forward concerning
her as an individual which might have placed her in an unfavorable light.
It was merely the collective aspect, that of the Nazi affiliation, which was
sufficient for her to be pushed aside. Not one of the mothers who rejected
her considered the possibility that she might have been in discord with her
father's views, or perhaps even of so-called non-aryan origin. Such findings
would indicate that if Mother No. 3 were still at the top of the list at
present, the longer the occupation of Germany and Japan lasts, the greater
may be the resistance built up by the families of men in the occupation
armies to their foreign brides, and the more hostility they would find upon
their return home.
TABLE 2
AUDIENCE ANALYSIS MOTHER ROLE
(Audience IX 25 persons)
Mother 1 16%
Mother 2 16%
Mother 3 20%
No Vote 48%
100%
In the case of the ninth audience a vote structure resulted which does
not resemble that of either the typical or the marginal audiences, see Table 2.
Nearly half of the group did not vote. This audience showed some preference
for Mother No. 3. The close contest between the three mothers was due
to the fact that the problem did not appear as a test to the audience, but
as a true case. The reason given for the slight preference for Mother No, 3
was that she was more outspoken. However, the striking thing about this
168
SOCIODRAMA 407
audience is the large percentage of "No Vote." Upon interview it was found
that a number of the spectators belonging to this group felt that "it was
not a test, but a real problem." They were convinced that the boy on
the stage was not an auxiliary ego, but that he presented his own personal
case. It was further revealed that many had the idea that the presumably
Nazi girl was in the audience and that they suspected several girls "from
the way they acted." The spectators had many other ideas of a delusionary
and illogical nature. An audience of mental patients might show such a
structure. However, these were not mental patients or disturbed individuals,
they were just highly sensitive to the procedure on the stage and to each
other (5, 10, 12), We have termed this type of audience a "sociotic" audience
and it is felt that, although it may not occur as frequently as the other two, it
represents a large faction of the population which must be dealt with. Such
an audience may, f.i. be apprehensive to certain films. Careful audience
diagnosis is therefore a perequisite to audience psychotherapy (8).
We plan a re-test of the same audiences for report at a future date.
It seems to us that this sociodramatic approach would lend itself to a
more intimate public opinion polling of representative samples than do pres-
ent methods. Expressing an opinion in these sessions is not left unrelated
to the voter's own life; his vote is motivated and taken only after he is
warmed up to the problem of which he is given a chance to see several
alternative solutions. The sociodramatic stimulus in an audience test can
be either extemporaneous sociodrama, a rehearsed sociodrama or an espe-
cially constructed diagnostic film. Motion pictures have been used at the
Institute for audience diagnosis and for therapeutic guidance. In the form
of the rehearsed sociodrama and the film, the audience to be tested remains
entirely spontaneous, only the process on the stage or screen is prepared and
conserved. Many agencies are using these "conserved" forms of sociodrama
today. In time to come it may well be that for use with large numbers of
groups the moving picture will supplement the rehearsed sociodrama in
the flesh because of its greater ease in reproduction.
Although apparently merely a testing procedure, this sociodramatic
approach has cathartic as well as diagnostic value. However, for guidance
purposes, in the case of both the rehearsed and film sociodrama, a "director
of the audience" must be present to use findings on the spot and turn these
findings into therapeutic channels. At times he may have to stop the film
in the middle, and/or to employ it as a step in the wanning up of the
audience to a self-presentation. According to Moreno, we cannot hope to
169
408 GROUP PSYCHOTHERAPY
use only frozen editions of psycho- and sociodrama. They should not be
regarded as took which can stand alone, but as adjuncts to actual psycho,
and sociodramatic sessions.
CONCLUSIONS
The sociodramatic audience test is presented as a diagnostic measure
for audiences.
To date two sets of standard life situations have been used at the
Psychodramatic Institute, the Three Situation Set and the Seven Situation
Set. The polarity, Role of the Stranger vs. Role of the Native, was used
to test our audiences.
Moreno's audience test is used, exposing nine audiences to the same
sociodramatic stimulus. Analysis of the vote is made and categories of
subjects are established. Audiences are subjected to the same theme and
the same auxiliary egos.
It was found that audiences could be classified as typical, marginal
and sociotic, according to the role configurations found within them.
The meaning of .symbolic roles was discussed and their bearing on
individual behavior.
Sociodramatic methods, spontaneous, rehearsed and in films, could be
used as measures of public opinion. It is foreshadowed that sociodramatic
films may eventually be used on a large scale. In sociodrama and group
psychodrama it is the audience which is the subject, and therefore con-
served forms should be supplementary to sessions in the flesh. An audience
director should always be present, especially in the frozen editions of psycho-
and sociodrama, in order to guide the findings on the spot into therapeutic
channels.
BIBLIOGRAPHY
1. Hendry, Charles; Zander, Alvin; and Lippitt, Ronald, "Reality Practice
as Educational Method," Psychodrama Monograph No. 9, Beacon
House, N. Y., 1944.
2. Moreno, J. L., Who Shall Survive?, now obtainable at Beacon House,
N. Y., 1934.
3. Moreno, J. L., "A Frame of Reference for Testing the Social Investi-
gator," Sociometry, Vol. 3, No. 4, October 1940.
4. Moreno, J. L., and Dunkin, William S., "The Function of the Social In-
vestigator in Experimental Psychodrama," Sociometry, Vol. 4, No. 4,
November 1941.
170
SOCIODRAMA 409
5. Moreno, J. L,, and John K. Fischel, "Spontaneity Procedures in Eele-
vision Broadcasting," Sociometry, Vol 5, No. 1, February 1942.
6. Moreno, J. L., "Sociometry and the Cultural Order," Sociometry Mono-
graph No. 2, Beacon House, N. Y., 1943.
7. Moreno, J. L., Sociodrama, A Method for the Analysis of Social Con-
flicts," Psychodrama Monograph No. 1, Beacon House, N. Y., 1944.
8. Moreno, J X., "Psychodrama and Therapeutic Motion Pictures, Psy-
chodrama Monograph No. 11, Beacon House, N. Y., 194S.
9. Moreno, J. L,, "Psychodrama, Collected Papers," Beacon House, N. Y.,
1945.
10. Toeman, Zerka, with Moreno, J. L., "The Group Approach in Psycho-
drama," Sociometry, Vol S, No. 2, May 1942.
11. Toeman, Zerka, "Role Analysis and Audience Structure," Psycho-
drama Monograph No. 12, Beacon House, N. Y., 1944.
12. Umansky, Abraham L., "Psychodrama and the Audience," Sociometry,
Vol. 7, No. 2, May 1944.
171
ROLE-PLAYING AS A METHOD OF TRAINING FOREMEN
JOHN R. P. FRENCH, JR.
Harwood Manufacturing Corp.
Marion, Virginia
The use of psychodramatic or role-playing methods in the training of
leaders is relatively new. 1 ' 2 Even more recently these same methods have
been applied to the training of foremen with such promising results that
the time seems ripe to describe the technique by presenting some concrete
case material and to delineate some of the problems and possibilities.
The following material is selected from stenographic records of the first
and last sessions of a training course conducted by the author as part of
a larger research program at the Harwood Manufacturing Corporation, a
sewing plant employing 650 workers. The training group consisted of the
department head (a man), the supervisors (as the foremen all women-
are called), and irregular attendants (such as the department trainer) in a
department of 100 employees. The Personal Manager, the Plant Manager
the Engineer and the President visited some of the training sessions.
Though limited to the area of interpersonal problems the conception
of supervisory training was unusually broad, for it attempted to improve per-
formance not only by teaching social skills to the supervisors, but also by
changing any other factors affecting their performance e.g. their position
in the factory, their relations to higher management, company policies, and
so forth.
After a brief introduction to the course with no mention of role-playing,
the first step of the first meeting was to get a rough diagnosis of felt train-
ing needs by asking the trainees to write down their most frequent, most
difficult, and most distasteful personnel problems. Since the management
had recently required the supervisors to prevent excessive talking among
the operators, this was the most pressing problem:
TRAINER: Well, they all have one thing in common, talking. That seems
to be our chief problem. Shall we start in on that?
ALL: Yes! (Very definite and strong decision.)
l French, J. R. P. Jr., Retraining an autocratic leader,-/, of Abnorm. & Soc. PsychoL,
VoL 39, 1944.
*Lippitt, R., The psychodrama in leadership training, Sodometry, Vol. VI, No. 3,
1943.
172
410
SOCIODRAMA 411
MARY: That's much our biggest problem.
TRAINER; O.K. Since things seem different here than out on the floor,
we will try to make it seem more realistic here and try to feel as if we
were out there. Bill, you come up here and run this machine. (Pulls
out a desk and puts two chairs behind it.)
BILL: (Walking to the desk). I'm being a guinea pig.
TRAINER: Evelyn, you sit here and be the girl beside him. (She gets up
and sits beside Bill, giggling a little.) Now Mary will go out of the
room and be the supervisor. Mary, you can go into that office there,
then 111 tell you when to come in. These girls will be talking, and you
are to be your self and tell them to stop and show us just how you do it.
(All are giggling a little and acting self-conscious and shy.) What I
want you to do is not just act it out in a funny way, but I want you to
be the operator or the supervisor and do just what you would do under
those circumstances. Mary, you be yourself and stop these two girls
from talking. Bill and Evelyn, you are girls and you're talking. O.K.
Go ahead. Start talking you two.
BILL: Well, Evelyn, if we've got to talk about something, we might as
well talk about this idea. What do you think of it, Evelyn?
TRAINER: No. that's not it. Girls won't talk about that.
BILL: Well, they talk about what they did last night and I'm not going to
do that! (Giggles again.)
TRAILER: Come on, be girls. Go ahead and talk about what you did last
night.
EVELYN: Well, did you go to the movies last night?
BILL: No, I stayed home and peeled onions!
TRAINER: O.K. Come in and stop them Mary. (Mary enters rather self-
consciously and leans on the desk laughing.)
MARY: Come on you girls stop talking. Now Bill (Getting completely out
of character,) you gotta give me a good answer!
TRAINER: Oh Mary, now you've spoiled it. You're supposed to be your-
self out there on the floor. You wouldn't say that to two operators.
O.K. Let's try it again. Mary, go back into the other room. (She goes
out, and Bill and Evelyn start talking again.)
EVELYN: Are you going to the movies tonight? How about going with me?
BILL: No, I can't,
EVELYN: Oh, please. You can go! (With real spontaneity.)
173
412 GROUP PSYCHOTHERAPY
BILL: Nope, gotta can liver tonight,
TRAINER: All right Mary.
MARY: (Speaking loudly in a scolding tone of voice.) You girls are making
too much noise. (Slipped out of her role for a moment and giggled.)
BILL: We're just talking.
MARY: You're not supposed to talk.
EVELYN: Why we've got to talk. You can't live without talking.
MARY: You can't t^lk. It bothers others. Now quit talking. Mr. Smith
(the Plant Manager) says there's too much boisterous talking,
EVELYN: If I can't talk I'm going to kick to somebody.
MARY: O.K. Suppose you go tell Mr. Smith down in the office.
BILL: If you're gonna talk that way, I quit! (Trainer stops the role-
playing.)
TRAINER: Good! Is that real, is that what usually happens? Bill, did it
seem real to you? (Bill assents.) Mary, did it seem realistic to you?
Is that the way the girls talk to you on the ffoor? (Mary assents.)
Well what about your giggling when you first spoke to the girls you
don't usually do that do you?
MARY: No.
TRAINER: Bill, you sure were talking hateful. Do the girls really talk
back to you the way you did to Mary?
BILL: They sure do! But I think Mary did it wrong. She should have
done it different. She should have asked us our reasons for talking and
she wasn't clear enough about why we shouldn't talk. She should have
explained more.
TRAINER: (Feeling that the criticism, though correct, will arouse ego-
defenses.) Maybe so, but first let's go back to the question of whether
this situation is real, I noticed that one girl supported the other. Do
they usually support each other against you? Do you usually have to
talk to two people at once?
MARY: (Apparently ignoring trainer's question and going back to Bill's
. criticism of her technique.) When I talked with two of them the other
day, I did explain more. I told them Mr. Smith said there was too
much talking, that it was too loud and boisterous, that it bothered other
people and slowed down the work and took their attention away from
their work.
174
SOCIODRAMA 413
TRAINER: Evelyn, you did some pretty tough talking. How did you fed
about it.
EVELYN: I would have felt better if she had spoken to me more quietly
and personally.
TRAINER: When there are two of you involved, doesn't she usually have to
talk to both of you?
EVELYN: I guess so, but she shouldn't have done it so loud. It made me mad.
TRAINER: What was it that made you so mad? And when you said you
would go to Mr. Smith, did you mean it?
EVELYN: Sure I did. I was good and mad.
In the ensuing discussion, the supervisors felt that appealing to the
authority of the plant manager annoyed the girls and weakened the position
of the supervisor. "You can't let them think you're afraid of them or that
you're job-scared!"
TRAINER: Well, we did a pretty good job on that one. Let's try it again
with Bill as supervisor and see if we get some more ideas and see how
differently he handles it from Mary. (Bill goes out of the room. The
two girls sit at the desk as operators. There is no silliness or giggling
this time. They get right to work and fit into their parts, seeming to
enjoy it and getting the idea very well.)
EVELYN: Are you going to the show tonight Mary?
MARY: I don't think so, went last night.
EVELYN: Wasn't that a good show? Gee I liked it. He was so handsome
and she was so good! (Evelyn seems to be very much involved. Con-
tinues talking enthusiastically about the show, her voice raised and
quite excited.)
BILL: (Comes in quietly and walks up to desk, leaning on it with both
hands. Waits a moment. Both girls stop speaking and look up at him.)
Girls, you all are talking too much.
MARY: Why Bill we weren't saying much.
EVELYN: We're doing our work all right aren't we?
MARY: Yeah, we're making our units aren't we?
BILL: (Hesitating for just a moment.) Maybe you two girls are making
your units, but they're others who aren't. Your talking bothers them.
MARY: We don't care about them. Let them look out for themselves.
We're doing all right.
EVELYN: Yeah. We do all right. And we gotta talk.
175
414 GROUP PSYCHOTHERAPY
BILL: We can't get the production out if you bother others and talk so
boisterous*
MARY: I don't care about production. I'm just working until I can get
a release anyhow. If you don't like the- way we act, go ahead and give
us our release.
EVELYN: Yes, give us our release. We don't care. But we gotta talk.
That's what tongues are made for.
MARY: Yeah. Tongues are fastened in the back and loose in the middle
just so people can talk! So let's get our release and quit. Come on
Evelyn. (Bill is flabbergasted and seems stuck. Trainer ends the role-
playing situation.)
TRAINER: O.K. Good! Bill you certainly got a couple of hateful girls
there. Are they often like that?
MARY: I used some of the same words a girl used on me the other day.
She went on explaining about how the tongue was made for the longest
time.
TRAINER: I was rather surprised when both of you asked for your release.
Would a girl ask for one as easily as that?
MARY: Sure. One told me the other day really that she wanted a release
and that she was just acting up so she could get it. What do you say
when they do that?
TRAINER: I see that is the way they have been doing it all along. This situ-
ation really seemed real then. Now how do you feel, Mary, when Bill
was talking to you?
MARY: Mad.
TRAINER: Mad at what?
MARY: At getting a scolding I guess. Maybe I felt guilty too. (Some dis-
cussion of a related incident on the floor follows.)
TRAINER: I know about that. But let's get back to this situation and the
other one. We've got two ways of handling the problem and let's make
a comparison. What was the difference between the way Bill handled
it and the way Mary did?
EVELYN: I still think that if they had spoken more privately about it,
we wouldn't have felt so mad.
TRAINER: I thought Bill did it pretty quietly.
EVELYN: Yes, but he spoke to us both at once. I would have felt better
if he had called me up and spoken to me alone.
176
SOCIODRAMA 415
TRAINER: I had the opinion that Bill did it more privately and quietly.
EVELYN: Yes, she just rushed in and scolded.
TRAINER: Which did it more firmly? Evelyn, you were a girl in each.
Which do you think?
EVELYN: I don't know.
TRAINER: Which was the more friendly?
EVELYN: Bill, I guess.
TRAINER: Which gave the most satisfactory explanation?
EVELYN: Bill, I believe.
TRAINER: (Boosting Mary's ego.) Bill of course had the second try. I
know Mary would have done it very differently another time. The first
time it is hard to do and hard to really be yourself. Now the time's up.
Do you want to stop or do you want to go on for a bit?
MARY: Let's go on. This is a tough problem and we've got to meet it
tomorrow and every other day, so let's find out how to do it.
EVELYN: Yes, let's get it settled.
BILL: O.K, Only don't let's stay after 5:30.
The discussion continued until the supervisors concluded that the girls
resented being asked not to talk because they did not understand that the
supervisors were carrying out a new company policy which applied to all
employees. So we decided to have group meetings of each production line
in order to explain the new policy on talking and the reasons for it.
The sixth meeting was devoted to the topic of how to talk to operators
about increasing their production. A brief discussion revealed that it was
standard procedure for every supervisor to show each of her girls the daily
production record and to try to get the inefficient operators to increase
their production.
TRAINER: Now that much is cleared up then, and I want to see how you
do it. So let's act it out as we did before.
BILL: Give me a cigarette first.
TRAINER: Sure, pass them around. I've got plenty today.
EVELYN : Don't ask me to do it. 1
The spontaneity of the role-playing in this meeting was less t.ha,n at intervening
meetings, probably because two superiors (the Personnel Manager and the Plant En-
gineer) were present as visitors.
177
416 GROUP PSYCHOTHERAPY
TRAINED; (Getting up to arrange a table as a machine.) All right. Mary,
who are the tough girls in your line. Who is a girl who can do more,
you are sure, and yet just isn't improving and hasn't for some time?
MARY: Well, Dixie is one, and that little new girl, the one who is making
pockets, Bill.
TRAINER: All right, let's take the little new girl. What's her name?
MARY: Oakie Shapely.
TRAINER: Do you know her Anne? (A supervisor attending for the first
time.)
ANNE: Yes, I know her.
TRAINER: Do you know her, Evelyn?
EVELYN: Pve never talked to her, though I know what she looks like.
TRAINER: Well, Anne, you come up here and be Oakie.
ANKE: Oh I'll just watch, Jack.
TRAINER: Oh you can come up and just be talked to. (She gets up, giggling
a little and sits at the desk.) Now remember you are Oakie Shapely.
Now let's find out more about you. What's your rating?
MARY: She rated 37 yesterday. Wasn't it, Bill?
BILL: Yes, 37. She's come up a dozen a day the last few days.
TRAINER: How does she feel about her work? Does she like her job?
MARY: She likes her job and tries hard.
TRAINER: That's good. She'll be an easy case then. That's a good one to
start on. (Moving a chair.) Here let's give Mary plenty of room.
(Much laughter from all.)
MARY: Oh talkin' doesn't take that much room Jack. (She comes over
to the table with a sheet of paper which the trainer has given her to
use as a daily production record.) Oakie, you made 37 units yesterday.
You are doing nicely. I'm proud of you. You said you were going to
make 37 and you did>
ANNE: Well, Mary, 111 try to make 38 or 39 now.
MARY: I hope you will and I'm sure you will.
ANNE: Well EH try. ^
MARY: I know you will try and I think you can make it all right.
TRAINER: (Breaking off the role-playing session.) OK. That's fine. That
was an easy case, where the girl already wants to cooperate. Now I
know a really tough one, Evelyn. Dottie Sholley.
BILL: Yeah. She's a tough one.
178
SOCIODRAMA 417
TRAINER: Have you been talking with Dottie lately, Evelyn.
EVELYN: I talked with Selma yesterday and Dottie today,
TRAINER: O.K. you show us how you talked to Dottie. Dottie has been
working on the job for two or three months hasn't she?
EVELYN: No, about six weeks. First we had her on another job, but she's
so little and the bundles were too big for her to carry. So we switched
her to pockets.
TRAINER: Oh. What's her rating now,
EVELYN: 37. She made 41 once.
TRAINER: And how does she feel about her production?
EVELYN: Oh she wants to do it, but she wants you to help. Today she
started to pick up two bundles. I met her at the table. I told her she
should only take one, and she said she wasted too much time getting
bundles and that when she worked in Bristol they had bundle girls who
brought the bundles to them, I needed the bundle for another girl, so
I told her to take one and that I'd bring her another. She said she
wanted me to be her bundle girl. So I was her supply girl all day.
TRAINER: O.K.. This is tomorrow and you find out she only made 30 units.
EVELYN: Oh Jack! After I carried her work to her all day, she only
makes 30!
TRAINER: I told you this was going to be a tough one!
EVELYN: That's too tough 1
TRAINER: Well, it sometimes happens that way.
EVELYN: I don't see what I could do if it happened that way.
TRAINER: Well, take a try at it.
EVELYN: (Getting up reluctantly and going over to Anne at the desk.)
Well, Dottie, you only made thirty units yesterday. Did you have any
special trouble? After I brought you all your work too.
ANNE: I didn't feel good.
EVELYN: Did you have any machine trouble or anything?
ANNE: Yes, I did.
EVELYN: Well, why didn't you put your little red light on?
ANNE: I don't know. I guess I forgot. And the thread breaks all the time.
EVELYN: Well, you should tell me about those things so I can help you.
You'll do that after this, won't you? And youTl try to do better too,
won't you?
ANNE: Yes, but I don't know if I can. It's hard to do.
179
418 GROUP PSYCHOTHERAPY
TRAINER: That's fine. Now let's talk about these two cases.
The discussion continues with suggestions of using check studies and
additional training. In the discussion of "making excuses", the Personnel
Manager thinks the supervisor should find out whether the girl has any per-
sonal problems. Because the trainer knows that Evelyn has caused resent-
ment by prying into the personal affairs of her girls and because he wants
to criticize the argumentative technique without criticising her personally
he sets up a special situation.
TRAINER: Let's see how Mr. Jones (the Personnel Manager) would tackle
this problem. I'll be the girl, the same girl Anne was last time. (Sits
at the "machine.")
MR. JONES: Well, it just seems to me this way. There's lots of things that
might be holding the girl bacL Possibly she got a letter from her boy
friend that had bad news in it, or something like that.
TRAINER: Well, let's try it out and see how it works.
MR. JONES : (Getting up from his chair.) What did you say your name was?
TRAINER: Dottie Sholley.
MR. JONES: (Now acting the role of supervisor.) I have some bad news
for you here, Dottie. It seems you have fallen down a little in your
units. What seems to be the trouble?
TRAINER: Well, I didn't feel so good.
MR. JONES: But when you asked me to be your supply girl you seemed
to be feeling well enough.
TRAINER: Well, I got some machine trouble and that slows me up. And
these old threads break all the time. You can't do much when that
happens.
MR. JONES: (Pause for a moment.) Did you go to the show last night?
TRAINER: No.
MR. JONES: Anyone in your family sick?
TRAINER: No.
MR. JONES: Did you have a date last night?
TRAINER: No! I'm married!
MR. JONES: And you say you haven't been feeling well?
TRAINER: No I wasn't feeling well, but that was just yesterday.
MR. JONES: You don't feel sick most of the time?
TRAINER: No* that was just a little stomach trouble. There's nothing wrong
with me!
180
SOCIODRAMA 419
MR. JONES: (laughing) You're sure bucking me. I give up!
BILL: If you let them get into an argument with you you'll never get out.
They answer and answer and answer.
TRAINER: Thanks. I certainly was being a tough one! ! Now let me give
you my reactions. When you came up saying you had bad news I
felt nervous. I didn't like that, so I was sort of on the defensive. I was
thinking, now what am I going to say? I thought of something, and then
while I thought of that I thought of something else to have ready for
the next question. Then he asked me about my family and that scared
me. I thought maybe something was wrong. Then he asked me if I had
had a datej and I was married. That made me so mad I nearly slapped
him. And when he asked me again about my health I tried to assure
him that I was in good health because I was afraid maybe he would
fire me if he thought I was sick all the time. Now, this is the toughest
kind of case you will get. A girl who doesn't do what she can do and
you just can't find out why. Now would you like me to try the skunk
oil method ?
BILL: Yeal, I think so.
TRAINER: O.K. You be the girl, Bill.
BILL: Sure, Pll answer your questions,
TRAINER: You try to be the same girl that Anne was and that I was. Be
as tough as you want to.
BILL: O.K. (Sits down at the table.)
TRAINER: (Approaching Bill with the sheet in his hands.) Hello Dottie.
Here's the unit sheet for today. Let's see, where's your name? (Turn-
ing the sheets with Bill's help.) I guess it's over on another page. What
have you been doing?
BILL: Well, I made 30.
TRAINER: How does that compare with what youVe been doing? Is that
good, for you, or not so good?
BILL: Well, I have done better.
TRAINER: How long have you been on the job?
BILL: Oh about eight or ten weeks, but they change me around so much.
TRAINER: How long have you been on this job?
BILL: About six weeks.
TRAINER: Well, it usually takes a girl three or four months to make 60.
You say you have done better?
181
420 GROUP PSYCHOTHERAPY
But: Yes.
TRAINER: Have any trouble yesterday?
BILL: Yes, the thread breaks all the time. And I had such little bundles. I
had to get more all the time.
TRAINER: Oh, I'm sorry. I told you yesterday I was going to bring you
a lot.
BILL: But they're too little. You run through them in no time.
TRAINER: What you want to do is not worry about your progress one day
or another day. How much do you suppose you will make a week from
today? Maybe you'll get some small bundles and maybe your machine
will give you trouble* but counting that in, what do you suppose you'll
make in a week?
BILL: I don't know. I might make 40 or 45.
TRAINER: You think you could make 40 or 45! Why I've known girls who
have taken three or four weeks to get up there from 30! What's the
best you have made?
BILL: I think it's 48.
TRAINER: Well, maybe you could then. How'd you like to try and make
40 by next Friday?
BILL: You mean just do 40 by next Friday?
TRAINER: Yes, that gives you a good chance in spite of machine trouble
and those things that you can't help that come up. Do you think you
could do it?
BILL: I believe so.
TRAINER: Now I don't think you can do it if you have troubles that aren't
your fault. Now on the matter of thread breaks, sometimes that's the
way you hold your cloth and sometimes the trouble is with the machine.
When you get trouble like that, we can have the mechanic in or we
can get the trainer over to see what's wrong. You want to have per-
fect working conditions. I'll come over Friday to see if you've made
it, and 111 come around every other day, too, to see if I can help in
some way. (End of role playing.)
MR. JONES: Fine!
TRAINER: I don't think I did that very well, but I was trying to use a
different technique. Now what's the difference?
MR. JONES: Well, you weren't on the defensive all the time.
TRAINER: You mean Bill didn't put me on the defensive?
182
SOCIODRAMA 421
BILL: What he means is when you were the operator you answered him
back. And I could answer all your questions to me this time, but there
never was any blame on me.
The discussion continued for fifteen minutes on the details of how to
avoid arguments, putting a person on the defensive, the use of production
goals, why the trainer tried to make a goal out of the lower of the two esti-
mates given by the girl, etc.
DISCUSSION
Compared with other methods of training foremen to handle interper-
sonal relations (e.g. reading, lectures, conferences and discussions, etc.) the
role-playing method has a number of distinctive characteristics. It is a dra-
matic* play-like activity on an irreal plane. Paradoxically, it is also very
concrete and realistic probably as close as possible to actual job perform-
ance. In a number of ways it is extremely flexible: the trainer can play a
variety of roles himself; he can assign the trainee any type of role; and he
can place the trainee in a wide range of situations. Finally, it stimulates
participation, involvement, and identification in such a way as to bring out
the deeper emotional aspects of interpersonal relations.
These four broad descriptive characteristics seem to result in a number
of more specific possibilities and advantages of the role-playing method:
L It helps in solving the vexing problem of the transfer of training
by providing a concrete and realistic setting wherein the supervisor prac-
tices what she must actually do in her real job. Each of the situations in
the above protocol is either a typical problem for these supervisors or a very
specific problem of one supervisor with a particular employee. Often the
problems are inaccessible to on-the-job training, either because they occur
infrequently or because they must be handled privately. In any case, role-
playing provides an excellent bridge from talking about interpersonal rela-
tions to actually handling them.
2. As the trainee performs, the trainer can coach her, immediately cor-
recting the errors and reinforcing the desired behavior; whereas on-the-job
training usually necessitates a longer gap between performance on the one
hand and reward and punishment on the other hand. In a life situation,
this gap makes it impossible to give the supervisor a knowledge of the
results of her^behavior except in a very vague way. But in role-playing this
can be done in a detailed and concrete way: for example, in showing the kind
183
422 GROUP PSYCHOTHERAPY
of behavior which produces "making excuses" the trainer could set up a situ-
ation to produce this behavior (cf. p. 11 ff.) and then get "introspections"
from the "employee."
3. Role-playing provides an excellent means for the essential first step
in successful training, namely the diagnosis of training needs. Verbal tech-
niqueslite writing down their most frequent, most difficult, and most
distasteful problems do not reveal the training needs of which they are un-
aware nor do they accurately describe the felt needs. In this case they merely
pointed out the known fact that the supervisors were unable to handle the
specific discipline problem of talking. But the subsequent role-playing
(cf. p. 4 ff.) revealed in the first minute that the supervisor was antagonizing
the employees by talking down to them and scolding them like children;
that in her insecurity she was appealing to the authority of the Plant Man-
ager and thus undermining her own authority; that she did not consider the
reasons why the employees talked; that she did not adequately explain the
reasons for the regulations against talking; and that she argued with the
employees. Not only does role-playing provide such opportunities for the
observation of training needs, but it even facilitates the use of test situations
to determine how well a trainee can actually handle various problems.
4. Sensitivity training is an important part of the training process, for
supervisors (even the women) are often insensitive to both the reactions of
their workers and their own methods of leadership. In the above case on
making excuses, the supervisors quickly became sensitized to the reactions
of the employees through the process of identification in playing the role of
the worker and through listening to the introspections of others in that role.
They gained insight into all the training needs mentioned above and into
more subtle problems like the relation between guilt feelings and defensive-
ness. Likewise they have an unusually good opportunity to become sensi-
tive to different methods and styles of leadership through seeing, in rapid
succession and under the guidance of the trainer, numerous leaders handling
the same problem. In the sixth training session (cf. p. 8 ff.) there were
three examples of different leaders handling the identical problem with
different methods.
5. Role-playing is effective partly because it increases the trainer's con-
trol of the social environment in a number of ways, (a) The trainee can be
assigned roles for specific therapeutic and training purposes. In the above
protocol the supervisors and department head played the roles of both
184
SOCIODRAMA 423
supervisor and worker; furthermore* they progressed from generalized roles
(cf. p. 4) to playing the roles of particular individuals (cf. p. 8). (b) For
purposes of demonstration the trainer can play the roles of supervisor and
worker; yet he can easily shift to the role of coach, observer, or discussion
leader, (c) The trainer can use all types of situations past, present, or fu-
ture. It may be a problem of discipline or production; but whatever the
area, the trainer can vary the type and difficulty of the situation to meet
the present training needs. For example, Evelyn felt strongly that one should
speak separately to two girls who are talking (cf. pp. 4, 6), so the trainer set
up a situation (in the second session) where she had only three minutes to
stop two girls from talking before she had to leave the department. When
the situation was played, it revealed that both girls just had to talk after she
left in order to find out what the supervisor had said to the other one. (d) In
setting up a situation the trainer can control the degree of reality-irreality,
not only as a whole, but differentially for the different parts; e.g. an ex-
tremely defensive supervisor (cf. p. 11) was criticized indirectly by replay-
ing the identical realistic situation, yet using a different person in the role
of supervisor in order to circumvent her ego-defenses, (e) Role-playing
helps the trainer to build an active and creative group because the technique
requires the participation of all group members in a way which ties in with
their own important problems. Passive listening without participation is
not nearly as much of a problem as it is in a conference or discussion group.
Often the dramatic aspect adds to the fun and enjoyment and improves the
group's morale (cf. p. 6). (f) Role-playing also tends to extend the trainer's
control of the social environment beyond the confines of the training session
and into the areas of the supervisor's position in the organizational structure,
her relations with other members of management, and even company poli-
cies. Thus the training can attack problems which are ordinarily outside
the realm of training. At the beginning of the course, for example, one
supervisor was refusing to accept the authority of the newly created depart-
ment head; but as their interpersonal relations were improved within the
training sessions, the actual structure and functioning of the department
changed out on the sewing floor. Because it inevitably reveals problem
situations, facilitates the diagnosis of these situations, and frequently sug-
gests solutions, we find that the role-playing naturally resulted in such
actions as group meetings to inform the employees of the new policy on
talking, getting the management to fulfill a broken promise to some employees
185
424 GROUP PSYCHOTHERAPY
by increasing their piece-work rate, clarifying the duties and responsibilities
of all supervisors in the plant, etc. Of course role-playing is only one tool in
achieving these broader results of training, and the greater the number of
levels in the institutional hierarchy which are included in the group, the
more effective it seems to be.
6* One of the most difficult problems of all training in the area of inter-
personal relations is the frequent rigidity and resistance to change which
stems from ego-defenses and other motivational factors or simply from ancient
habits. Role-playing is an effective method of combatting these resistances,
for its irreal character means that the supervisor is not playing for keeps
and there is less ego threat in trying out new patterns of behavior. This
freedom from fear on the part of the individual supervisor is paralleled by
a freedom and fluidity of the training group which makes possible and suc-
cessful a new method of leadership which could not even be tried in the
real situation. In the above protocols there is considerable ego-defensiveness,
yet it is definitely less than that encountered on the job beforehand and
even after the course. Probably it could have been further reduced by
making the role-playing less realistic.
7. Both in changing the supervisory techniques of individuals and in im-
proving interpersonal relations within the institutional hierarchy, role-play-
ing seems to provide a useful catharsis. In the first attempt (cf. p. 2 ff.)
every trainee showed the typical forms of resistance to playing a role:
giggling and self-consciousness, talking about the role instead of playing it,
dropping out of character, and not wanting to play a role. But surprisingly
quickly they warmed up to the point where they were playing a role with
real feeling and some enjoyment. At this point it became evident that the
role-playing provided a release for feelings and emotions. Mary, for exam-
ple (cf, p. S) was very evidently relishing her role and playing it with gusto
when she told the supervisor that "tongues are fastened in the back and
loose in the middle just so people can talk!" When it came out that she
had been on the receiving end of this same remark from one of her own
girls, it seemed probable that she released a tension which would other-
wise have disturbed her relation with this girl. Such catharsis seemed to be
even more effective in the relations of the supervisors to their superiors.
Probably something of this kind was involved in their frequently expressed
desire to have the trainer play the role of supervisor,
8. There are some reasons why role-playing seems particularly adapted
186
SOCIODRAMA 425
to the training of foremen. In the first place a foreman must often play a
role and a very difficult one at that in his real job. In some respects
he is a worker while in others he is a member of management, and he is
always at the fulcrum of conflict by virtue of his position in the industrial
hierarchy. Thus the problems of position and status are unusually acute for
him, and role-playing seems particularly adapted to handling such inter-
personal problems.
In the second place, foremen want concrete and specific help with their
daily problems; they have little patience with abstractions and generalized
advice. But in their interpersonal problems it is usually impossible to give
this concrete type of help except through role-playing because the problems
are inaccessible to on-the-job training.
Finally, the competitiveness of industry put a premium on efficiency;
and role-playing is efficient because it can accomplish with a whole group at
the same time what would otherwise have to be done individually.
187
ROLE TESTS AND ROLE DIAGRAMS OF CHILDREN
A Psychodramatic Approach to an Anthropological Problem
FLORENCE B. MORENO AND J. L. MORENO
Psychodramatic Institute, Beacon, N. Y.
INTRODUCTION
In the course of psychodramatic research, it has been frequently
postulated that the role is the most important single factor determining
the cultural atmosphere of personality. "The tangible aspects of what is
known as 'ego' are the roles in which he operates. ... We consider roles
and relationships between roles the most significant development within
any specific culture."*
In the drama, the taking and playing of roles are natural reference
points. One does not refer to the private Mr. X, who plays the role, but
to the role which he plays. The attitudes which he has as Mr. A do not
matter to begin with. What matters are the attitudes in the role. The
attitudes which may be characteristic of an actor as a private person, for
instance, John Barrymore, are not relevant here; what is relevant are the
attitudes which are supposed to be characteristic of a specific role, Hamlet.
The recent studies of attitudes, such as dominance and submission,
etc., do not seem to the authors as productive as the working with "roles" as
points of reference. It appears to be a shortcut and a methodical advantage
as compared with personality or ego as points of reference. The latter are
less concrete and wrapped up in metapsychological mysteriousness.
The authors have tried to examine this assumption by setting up a
specific program for role research. Since Binet introduced a test to measure
intelligence, frequent efforts have been made to construct a test measuring
"personality". Perhaps no test to study personality shows so much promise
as a "role" test because of the close interaction of the role process with
personality formation, on the one hand, and the cultural context of situa-
tions, on the other hand. As, according to premise, the role range of an
individual stands for the inflection of a given culture into the personalities
belonging to it, the "role test" would measure the role behavior of an
*Moreno, J. L., "Psychodramatic Treatment of Marriage Problems," Sodometry,
VoL 3, No. 1, 1940. The authors, consciously, do not try to define what "culture" is.
They prefer to let a definition grow out of experiments like these.
188
426
SOCIODRAMA 427
individual, and thereby reveal the degree of differentiation a specific culture
has attained within an individual, and his interpretation of this culture.
Just as the intelligence test measures the mental age of an individual, the
role test can measure his cultural age. The ratio between the chronological
age and the cultural age of an individual may then be called his cultural
quotient.
PROCEDURE
The project has been set up in two places: one in a small town-
project A, and the other in an underprivileged section of New York City-
project B.
In project A, a jury of five persons in the community where the children
live had been formed to determine the characteristic roles of the community,
presumably the roles they will have to perceive or act in, in the future.
A total of 55 roles were quoted by the jury as follows:
mother-father, brother-sister, doctor, nurse, teacher, gardener, maid,
policeman, mailman, minister, taxicab driver, electrician, carpenter,
fireman, telephone operator, painter, cook, president, mayor, citizen,
post office clerk, railroad ticket agent, expressman, librarian, barber,
beautician, waiter, butler, undertaker, pilot, soldier, sailor, general,
automobile mechanic, factory worker, factory foreman, bus driver, post-
master, coal man, radio entertainer, ice cream salesman, architect
(building contractor), lawyer, engineer, conductor, storekeeper, judge,
banker, plumber, butcher, baker, druggist, milkman, psychiatrist,
gas station man.
The following fifteen roles have received their highest preference scores:
mother-father, brother-sister, policeman, teacher, doctor, taxicab driver,
mailman, minister, plumber, banker, lawyer, railroad engineer, con-
ductor, storekeeper, judge.
The set of roles used for the test, it was agreed, may vary from one
community to another, and more drastically, from one culture to another.
The selection of the roles to be tested is of crucial importance, because
if the roles of which the set consists are only incidental to the life of that
particular community, no true picture of the child's role behavior and
potentialities can be attained. Therefore, the point was to select such roles
which are truly representative and operative in the community in which
the testees live.
In differential anthropological studies, comparing two cultures, the task
would be to determine identical role patterns (such as soldier or priest)
189
428 GROUP PSYCHOTHERAPY
and the ^-Identical role patterns, that is, such roles in one culture for which
there are no correspondents in the other (such as scientist and airplane
pilot, for which there is no parallel in pre-historic cultures).
In project B, a parallel procedure was established. A jury of five,
living in the neighborhood from which the children were selected, was
chosen. They, too, have each been asked to select the roles which they
would consider characteristic for the community in which they live. No
limit was set to the number of roles they could list. They listed 105 roles,
nearly twice as much as the jury in the small town (project A). They
proceeded, then, to select from their list the fifteen roles most pertinent,
in their judgment, for the children to act in and to understand. Their final
list was finally compared with the one listed above for project A, and a
discrepancy was found between the two lists of roles. Ten roles were the
same; the following five were not listed: mailman, plumber, minister (but
replaced by priest), banker and railroad engineer.
In project A,* the role test, as applied to individual subjects, was
divided into two procedures: (a) role enactment, and (b) role perception.
The division was made for analytic reasons, although actually, enactment
and perception cannot be fully separated.
The test was given to a large number of children. The test results with
six children are here presented. (See Table 1 for details.)
Description of Test
A child was asked to enact one after the other of the fifteen selected
roles. In order to reduce self-consciousness to a minimum and aid in his
warming up to their enactment, the entire procedure was presented to the
child as a game. An older child, coached as an auxiliary ego, served as
an audience to guess what each role was, after the subject had enacted it.
In order that the subject might not feel that attention was being focussed
especially upon him, or if he refused to enact the roles, the auxiliary ego
enacted a role, not included in the selected fifteen, and the subject guessed
what role it was. This interaction usually served as a starter for the subject.
The instructions were: (1) Show us what he (a policeman, a teacher,
etc.) does. (2) If the subject hesitated after a time, or indicated that he
had finished the enactment of the role, he was asked: "What else does he
(the policeman, the teacher, etc.) do?" (3) If the subject was unable to
warm up at all to the enactment of a role, he was asked: "If you cannot
*The results of the tests given in project B will be presented in a subsequent paper.
190
SOCIODRAMA
429
act, tell us what he (policeman, teacher, etc.) does." (4) If the subject
described the role correctly, he was urged again to try and enact it.
Once the roles were established which the subject was unable to enact,
an effort was made to determine whether they were able to recognize them.
They were enacted, then, by the same adult in a standardized dramatic form,
with each role phase occurring in a standardized sequence. Every role was
divided into a series of meaningful acts of which it consisted. One child
might recognize a role after seeing one or another characteristic act of it,
for instance, an attitude of the body or a gesture. Another child might
have to see two or more act phases in order to recognize a role. But even
among the roles which a child was able to enact, there might be a varying
degree of inadequacy, for instance, a child might enact only one or two
phases of a role, and deem it sufficient, either because she did not warm
up to more (although she might have been aware of more), or because
her awareness was limited,
RESULTS
The following shows samples of results from the role tests given to two
of the children, who live in the same community, are neighbors and friends
since they were two and a half years old, are of the same chronological
age (6 yrs.) and above the average in intelligence (118 and 140). (Every
role enactment is broken up (1, 2, 3, etc.) into its significant phases.)
RITA
Policeman 1. Stands still, waving hands as
if directing traffic, says, "AH right,
go this way." Motions with hands.
2. Changes position thus indicat-
ing being in another part of town,
and says (as if to someone):
"You're arrested because you stole
something-"
3. "H you shoot, 111 kill you."
Teacher 1. Directing conversation as if
to a group, in condescending and
serious attitude: "Now children,
you may paint and color, or do
whatever you wish."
2. "Later, we go out and pky."
Street-cleaner 1, "Now we have to dean the
streets,"
2. "Here is the brush so the
road can be clear." Makes mo-
tions of sweeping as though using
the long-handled brush of the
street-cleaner.
191
KAY
1. "What am I supposed to
do?" (Child auxiliary ego en-
acts another role; still does not
warm up.)
Perception: When the tester
enacts the role in all its phases,
she recognizes the role.
1. "I don't know."
Perception: Recognized role
after one phase of enactment
1. "I dean streets." To tesN
er: "I don't know what to do."
430
GROUP PSYCHOTHERAPY
RITA
Storekeeper 1. "Could I have some bana-
nas? How much are they?" (tak-
ing the role of customer).
2. Moves around as if coming
behind counter, opposite customer:
"$25."
3. Coming back to position of
customer: "All right, 111 take some."
4. Offers money to storekeeper.
Judge 1. "Get out of here. What did
you do to that lady?"
2. 'Write her name down. She is
a naughty lady."
3. Aside to adult: "He's in the
court house."
Doctor 1. "Now, children, let me exam-
ine you." Makes gesture and mo-
tion to hold child's head. Uses doll.
Takes a stick (tongue depresser)
and attempts to put it into doll's
mouth. "Now what's happened to
this little girl? She has broken her
neck. I will put something in it."
Takes scissors and cuts strips of
paper.
2. "Now here are some piDs for
her."
3. Puts pieces of paper on child
for bandage, and makes gesture of
giving pills,
4. "Now how much is that?"
5. "It's $50."
Mailman 1. Asks for something to repre-
sent letters. Is given empty enve-
lopes. Walks towards various spots
in the room slipping them behind
chairs, saying: "This belongs to
Miss Tara. Where's her mafl box?"
2. Throws letter behind chair.
3. Takes another, saying: "This
is a card for Mrs. Jones. Here's
her mail box." Likewise throws it
into space behind another chair.
4. "This belongs to Mrs. Sweet,"
and so on, putting them all in dif-
ferent places,
5. "He now goes back to post
office."
Minister 1. "I don't like that one."
2. Stands up straight as if facing
an audience: "All right, say your
prayers."
3. "AH right, we're ready to
sing." "O.K."
192
KAY
1. "I don't know."
Perception: After first phase
of enactment, recognizes role.
1. "I don't know."
Perception: Didn't recognize,
role after complete 'enactment.
1. In weak voice: "I take
care of people when they're
sick."
1. "What am I doing? I'm
giving letters." Stands still.
Makes gestures with her hands
as if dealing out letters.
1. "Don't know it."
Perception: After complete en-
actment says: "Person in church;
priest?" (She is a protestant.)
SOCIODRAMA
431
Taxicab
Driver
Lawyer
Plumber
Railroad
Engineer
Conductor
RITA
4. Makes motion of pulling rope
of church bell, saying: "Ding, ding,
ding."
5. "O.K,, everybody out."
6. Makes imitative gesture of
opening the doors.
7. "Now he stands there and
talks."
8. "They just pray and sing."
1. "Is this your stop, lady?"
2. "Where do you two ladies
want to go? Amusement park?"
3. "Where do you two ladies
want to go?"
4. Has hands around wheel,
makes motion as if driving, saying:
"Honk, honk."
5. "All right, here's your stop."
6. "Toot-toot"
7. "The swimming pool? All
right."
8. "Is this your stop? How
much money?"
"Oh, that's too hard I don't
know."
KAY
Perception: "don't know."
1. Gets way down on stomach,
saying: "I have to look at this sink.
Have to get this ring out of here.
Here, little girl, is your ring off
the pipe."
(a) "Anything else? Pipe is
broken? Well, 101 have to go out
and get my tools."
2. Goes out of the room, comes
back with some sticks. Grunts:
"Ooooh!" as she gets down. "Have
to get this nafl in here." Works on
it for some time,
3. "Oh, darn it. There, now."
Polishes it.
4. Now Fve got to take my
tools and everything away." Takes
objects and walks out of room.
1. Holds hand up as if hanging
on to something: "This is the wheel.
I'm driving it." Aside to adult:
"He doesn't call out the stations.
He drives the engine."
1. "Your tickets, please."
2. "Horaell, Hornell, next stop."
3. Walks as if walking up the
aisle of train and looks from one
1. Puts hands up as if on
wheel, driving car: "Chog-a-
chog."
2. "I have to stop and let
people on."
3. "Now I'm going to pull
the brake." Makes motion as
though pulling the brake.
1. "Don't know,"
Perception: "Don't know."
1. "Don't know; I don't
know."
Perception: "Don't know."
1, Don't know how to act
it."
Perception: "Train driver."
After a pause: "Engineer."
1. "I take tickets." "What
shall I do? I don't know."
193
432
GROUP PSYCHOTHERAPY
1. "Don't know."
Perception: "Mother and fath-
er." Recognized the role after
complete enactment.
Perception: "Don't know."
RITA KAY
side to another, leaning over as if
taking tickets from passengers.
4. He says; "Come on the train.
Hurry up." (An aside to adult.)
Mother- 1. "I shall wash the dishes and
Father make the house tidy." Moves about
making motions as though sweeping.
2. Changes her voice to lower
pitch: "I shall work and go to
work hard in factories earn some
money and gold. I go out to chop
wood and saw it."
3. Changes position again and
voice: "I mop the floor; cook for
the kiddies. I shall go out and
sweep the floor."
Banker 1. "How much money do you 1. "Don't know."
earn? I have to."
2. "Now I can get my checks
out. Here's my own checking desk.
I'll give out money to people."
3. Takes up telephone and says:
"Are you coming to the bank, too?"
The foregoing sample of responses show the two extreme reactions of
children both above the average in intelligence, the one, Kay, of the superior
intelligence being unable to warm up to enacting most of the roles, along
with having a surprisingly low level of role perception. This same child
showed also a comparatively low s factor in spontaneity tests. She is a
sensitive, intuitive child with superior musical ability. She was from early
childhood fearful of other children, and until the age of four, cried con-
tinuously when approached by other children in a group. An early socio-
rnetric study (1) had been made of the particular nursery school of which she
was a member, and her position was that of an extreme isolate.* In the last
two years, her development has changed considerably. She has become the
aggressor, has appeared anything but inhibited in her social relationships,
and, upon superficial observation, one might call her "much more spon-
taneous." However, when placed in specific spontaneity tests recently, her
social spontaneity still seemed to lag. In the role tests, she reacted enthusi-
astically to the "game" idea, and although she saw a sample of a perform-
ance, and could describe what some of the various roles were, she was
*In the artide, "Sociometric Status of Children in a Nursery School Group," Sod-
ometry. Vol. S, No. 4, November 1942, Kay goes under the name of Mildred, and Rita,
under the name of Florence.
194
SOCIODRAMA
433
unable to warm up to their enactment. Rita, in contrast, is not so capable
in musical ability as Kay, nor so meticulous in writing and manual dex-
terity, but has shown a high s factor on other spontaneity tests. Her
sociometric position in the same nursery school was neither that of isolation
nor extreme popularity. She had, however, a far greater number of incoming
choices, but reciprocated the choice of only one child, with whom she
appeared to play the most throughout the study. In sum, Kay is far less
resourceful in meeting emerging situations, particularly social, is much more
bound to stereotypes, as is apparent in her musical expression and in draw-
ing tests. Taking Kay's low role score and the foregoing factors into account,
there are indications that a low s score goes hand in hand with a low
sociometric and a low role score.
TABLE 1
ROLE SCORES
(Number of Roles Scored: IS)
Enactment
Number
Number below
of role
of role level of
Partial Distorted Adequate
enact-
percep- recog-
enact- enact- enact-
ments
tions nition
ment ment ment
Rita
(6 yrs., 4 mo.)
14+
13+ 1
7 5
I.Q. 118
1-
2
Ella
(6 yrs., 9 mo.)
13+
13+
V/2 ft 2
I.Q. 135
*
n
Jerry
(6 yrs., 2 mo.)
9+
9+ 1
7 1
I.Q. 108
6-
6-
Freddie
(8 yrs., 6 mo.)
7+
5+ 3
3 1
I.Q. 85
8
8
Kay
(6 yrs., 2 mo.)
2+
7+ 1
1
I.Q. 140
13-
8-
Jean
(4 yrs., 10 mo.)
LQ. 120
7+
8
Key: 9+ means that nine out of the fifteen roles were enacted.
Example: 6 means that six roles out of the fifteen roles were unenacted
195
434 GROUP PSYCHOTHERAPY
TABLE 2
ROLES ENACTED
(Total Number of Roles: 15)
Jerry Jean Freddie
Kay Ella
Rita
Policeman
X
XX
XX
XXX
Teacher
X
XX
XX
Lawyer
X
RJR. Engineer
X
XX*
XX
R.R. Conductor
X
XX*
XXX*
Storekeeper
XX
XXX*
XXX*
XX*
Judge
X
Mother-Father
XX
XX
XXX
Brother-Sister
XX
XX*
XX
Doctor
X
XX
XX*
Banker
XX
XX
Taxicab driver
XX
XXX
XX* XXX*
XX*
Mailman
XX
XX
XX XX*
XXX*
Minister
XX*
XX*
XX
Plumber
XXX*
XXX*
Key:
x means enactment below the level of recognition,
xx means partial enactment.
xxx means complete enactment.
* means that this particular role has been enacted with the greatest degree of
dramatic quality, that is, the intensity of warming up to the role, the longest
duration of enactments, or the greatest amount of details with respect to gestures
and verbalizations,
ANALYSIS
For the purposes of refining the scores, and in order to give as much
credit as possible to all attempts at enactment, the scoring has been divided
into various levels of performance, as follows:
(a) Enactment below the level of recognition means the inclusion of
elements remotely related to the role but not sufficient for its recognition.
(b) Partial enactment means including one or two recognizable phases
of the role.
(c) Distorted enactment means the enacting of characteristics largely
unrelated to the assigned role. The child may include bizarre formations
of the role.
(d) Adequate enactment means the inclusion of all significant phases
of the role as evaluated by the jury.
Role Stability
Ella and Rita have the highest role range, 14:1 and 13:2. Both are
above the average in intelligence with Ella leading by about ten points.
196
SOCIODRAMA 435
Although Ella is a few months older than Rita, and of higher intelligence,
Rita is about equal to her in role performance. These figures, however, do
not reveal the great qualitative differences in their performances. For
instance, in certain roles, Ella was far more dramatic than Rita, in the
sense that she chose to elaborate upon one or two phases of a role with
extensive gestures, movements, and verbalizations, rather than to include
all phases of the role as Rita did. This excessive dramatization on the
part of Ella led into role instability; the fact that she was unable to contain
herself within the roles enacted shows that the thresholds between her roles
were thin. She was so carried away by the dramatic aspect of her spon-
taneity that she did not visualize a complete pattern of the role with its
closures; that is, her undisciplined spontaneity carried her, upon the sug-
gestion of a role, from one role to another. This produces, furthermore, an
uneven clustering of roles. The following is just a sample of this point in
her role of the "teacher":
"Children, you must read today. You must learn your lessons well
and everything else. If you do your lessons well, we will go to the
museum. We will have to ask our principal, Mrs. Brown," She then
became slightly grotesque, swayed back and forth with her arms raised
up, still facing the audience, however, and said: "I'm the biggest fat-
test lady in the circus. 7 ' And then, became a barker in the circus, and
shouted: "Right this way to see the elephants and clowns, right this
way, etc."
Rita, on the other hand, in certain roles, included all significant phases
briefly and finished in half the time of Ella's performance of one or two
aspects of a role. However, in other roles, Rita was highly dramatic and
enthusiastic, but at no time on an uncontrolled spontaneous level.
Relationship of Intelligence to Role Scores
The results are not complete enough to draw any definite conclusions
concerning the relationship of intelligence to cultural maturity. However,
Table 1 indicates that high intelligence may cause a higher role score, but
not necessarily, as is evident in the situation of Kay, who, though only
seven months younger than Ella, is disproportionately inferior to her in
role performance. This strengthens, furthermore, our previous assertions
that the Binet 'intelligence test is limited, insofar as it is not able to measure
role behavior. As the study is in progress and is extended to a larger
number of children, more refined role scores will be derived, and eventually
role quotients, which can be correlated with intelligence quotients.
197
436
GROUP PSYCHOTHERAPY
Individual Responses of the Same Role
We are able to study the degree of cultural differentiation to a great
extent from Tables 1 and 2. Highly important, too, is the cultural differen-
tiation with respect to its interpretation. In the role of the policeman, for
example, he was regarded by two of the children as a sort of robot director
of traffic. Rita has presented him as a traffic policeman (with more flexi-
bility than that of a robot), as one who has the power to arrest people, and
as one who deals with gangsters, involving shooting and killing. Freddie
emphasized only arresting and going to jail. In the mother and father
roles, Ella, Rita, and Jerry respectively emphasized the maternal-paternal-
child relationship, hinting at the conflicts involved; the specific duties of
each parent, such as domestic and the role of supporter; and the mother
alone, particularly the maternal and domestic aspects. The following illus-
trations confirm this:
ELLA
In a high voice: "Now
honey, you must sit down
and have your breakfast.
Susan, do it. Daddy said
to do it. I'm going to
turn you over my knee
and spank you. You're
going to bed." She
changes her voice to nor-
mal, and says: "Now I'm
dad." Changes her voice
to a lower pitch: "Moth-
er, what are we going to
do with this girl? She's
not good at all. Now you
go to bed; now, say your
prayers . . ." (uses teddy
bear) Pretends to put it
to bed. Changes voice:
"Now, I'm Mom." "I
have to fry an egg.
Darling, hold your plate
out. I spent a long time
at it."
RITA
"I shall wash the dishes
and make the house tidy."
Moves about as though
sweeping. Changes her
voice to lower pitch: "I
shall work and go to
work hard in factories
earn some money and
gold. I go out and chop
wood and saw it."
Changes position again
and voice: "I mop the
floor; cook for the kid-
dies. I shall go out and
sweep the floor."
JERRY
"Come on, baby, you
have to go to sleep, now.
Rest your legs." Makes
motions as though laying
a baby down. "I guess
111 straighten the house
up." Starts to pick things
up in the room, losing
herself completely in the
role, as she goes about
systematically to dean and
and rearrange the room
she is in. Spends consid-
erable time at this, and
would have gone on do-
ing so if tester did not
terminate this particular
scene. She was prompted
by tester: "What about
father?" She answered:
"Oh, he does the work
with things. Comes home,
eats his lunch and eats
again. Goes back to work
shop to fix things." Test-
er says: "Show us."
Seems unable to warm up
to action in role of father.
Role Dominance as a Factor Influencing
Interpersonal Relations
We see from Table 2 that all the children, with the exception of Jean,
enacted the roles of the taxicab driver and the mailman. In the role of
198
SOCIODRAMA 437
the taxicab driver, three of the children were particularly strong. The
storekeeper was enacted by four of the children. The lawyer and judge
were out of the present cultural range of all of the children. Diagram 1
shows the interrelationship of roles, pointing out the clashes of dominant
roles, which is an important explanation for the attractions and repulsions
of Rita, Ella, and Kay. It can be seen here that Ella and Rita are mutually
strong in certain roles. It is not surprising then that when the three girls
are together, there is bitter conflict between Ella and Rita for role domi-
nance over Kay, who has only two roles which are important to her and
at the same time to her two companions. When Kay is alone with only one
of the other two girls, their strong roles realize their fulfillment in Kay's
passive responses to them. When the three girls are together, Rita and
Ella are struggling to overcome the counter-spontaneity and counter role
dominance of each other, and competing to exercise their role powers over
the weaker Kay, The conflicts among the other children are less noticeable
possibly because of their weak role ranges and weaknesses in wanning up
to enactments altogether. Jerry and Rita appear quite compatible in their
play; this may be attributed to Jerry's strong mother role being comple-
mented by Rita's weak mother role, and Jerry's strong minister role being
balanced somewhat by Rita's verbal rejection of the role, even though she
attempted to enact it. Thus, it can be seen, due to the findings of the
role test, that the charting of attractions and repulsions can be further
elaborated by role diagrams. It reveals a deeper interpersonal structure,
breaking up, on the one hand, the individual into the roles in which he
manifests himself, and, on the other hand, giving the attractions and re-
pulsions phenomena a socially tangible reality.
GENERAL DISCUSSION
One of the outstanding features of this study is the problem of enact-
able and unenactable roles. Why is it, for instance, that in some cases the
most easily enacted roles come from the more remote social experiences
rather than in the immediate primary experiences, such as in the home
and/or school? Why is it that some children appear to derive a certain
thrill or excitement out of experiencing the roles of the taxicab driver,
mailman, or conductor rather than the mother-father roles? Why is it that
some children need to objectify the roles and define them within themselves,
perhaps verbally or pictorially, before they are able to enact them, while
other children warm up immediately to certain portions of the role with
no apparent plan of action?
199
438 GROUP PSYCHOTHERAPY
We recall that for the same children when they were three to four
years old the exciting thing was to play mother, father, brother and sister.
Now, little more than two years later, these roles are apparently taken for
granted. In their expanding world other roles, like policeman and mailman
seem much more adventurous. But these observations have a deeper and
more fundamental explanation still. It is based on the theory of the matrix
of identity.*
Before elaborating upon an explanation, a summing up of our con-
clusions drawn in an earlier paper may be appropriate. According to
spontaneity theory, the infant is not thrown into the world without his
participation. He plays a fundamental part in the act of birth. The factor
by means of which the infant is self-propelling himself into life is called
spontaneity. This factor is aiding the infant during the first days to main-
tain himself in a strange new world against great odds. At a time when
memory, intelligence, and other cerebral functions are yet little developed
or non-existent, the s factor is the mainstay of the infant's own resource-
fulness. To his support come the auxiliary egos and objects with whom
he forms his first environment, the matrix of identity. We differentiated
between (a) a period in the child's infancy for many phases of which he
has later a true amnesia, and (b) a period in the child's infancy in which
the function of dreaming develops and in which the functions of memory
and intelligence gain in strength. It is probable that for certain children
the matrix of identity is extended beyond its usual time point of termina-
ton. They apparently need a prolonged period of psychological incubation
(mother, father, and other auxiliary egos being the helpers).
Due to the co-experiencing of the maternal or paternal roles, the roles
become so much a part of the child's self, that it is easier for him to "be"
them in a spontaneous casual activity than it is for him to act the roles
out, on the spur of the moment, when presented with the verbal stimulus
"act the mother". The more these roles have become a part of the self,
the more difficult it will be in later years for the child to enact them,
particularly when he attempts to put them on the level of conceptual learn-
ing, for it is in the earliest stage of role assimilation (matrix of identity)
that tie child is experiencing a form of living which is pre-##conscious as
weH as it is pre-conscious; it is strictly act living. The later way of assimi-
*Moreno, J. L. and Moreno, F. B., "Spontaneity Theory of Child Development,"
Sodometry, vol.
200
SOCIODRAMA 439
lating a role is through conditioning, perception, and objectification. Since one
of the first role experiences is the mother role, it can be seen how difficult it
might be for a child to reproduce it when he attempts to put it on the
level of objectification and perception. It is difficult to give birth to a role
which is fully integrated into the self. It is with the parts which are
^integrated that he is able to act out a role, carrying with them the parts
of the role which have been apparently dissolved within the self. Social
roles such as policeman, doctor, etc., are obviously more or less unintegrated
into themselves to start with. In principle, at least, the difficulty of enact-
ment is less great. Children are far more dependent here upon their ability
to perceive their social significance. However, the spontaneity with which they
warm up to them, they apparently draw from older role connections (mother,
father roles) which are deeply integrated into themselves. For the child,
furthermore, who attempts to put such roles as the mother and father on
the conceptual level, the clustering of roles within the mother and father
roles complicates warming up to their enactment* However, although un-
enactable, there seems to be a transfer of spontaneity from these role
clusters to other roles, for example, from father to policeman, etc.
Therefore, children who enact the maternal or paternal roles, for exam-
ple, easily without any preparation are those who have been greatly im-
pressed with the social and more immediate aspects of the role and are
able to keep these fairly well apart from the older and deeper experiences
of it. Since "the mother" is not a single role but a cluster of roles,* certain
of its older manifestations may be deeply disturbing to a child and so
puzzling that she is not able to enact them; for other parts she may have
a true amnesia (not merely "forgetting" because of repression in the psycho-
analytic sense). This sums up to the following: Certain children are able
to confine the mother experience to its social and surface manifestations,
and thus they can objectify and enact the role. Other children cannot con-
fine the role to its immediate social context. They are, at least within
themselves, if not also externally more deeply dependent upon co-acting
with the mother in a mutually developed matrix of identity, so that these
children are, perhaps, less mature, and, few: tibis reason, more spontaneous.
By this trick of their minds, they can draw also from the spontaneity of
the mother as if it would be their own.
*The mother role might include a clustering of such roles as wife to the father,
companion to him, homemaker, nurse to the child, etc.
201
440 GROUP PSYCHOTHERAPY
For certain children, even socially facile roles, such as the plumber,
storekeeper, etc., seem difficult to enact. It seems that their ability to trans-
fer the s factor from earlier configurations is weak. On the other hand,
their dependence upon their perception, via memory and intelligence, is
an insufficient impetus to enactment. They will have to become much older
and more mature until their weak spontaneity will be amply compensated
by a fuller comprehension and assimilation of role-stereotypes and conserves.
For all children of this study, it remains to mention that certain roles have
been unenactable, such as the lawyer and the judge, because they have
not yet entered their orbit of experience.
CONCLUSIONS
1. The role test is based upon the premise that roles are the most
important single factors which determine the cultural character of
individuals.
Working with the "role" as a point of reference appears to be a
methodical advantage as compared with "personality" or "ego." These are
less concrete and wrapped up in metapsychological mysteriousness.
2. In the two processes examined, role enactment and role perception
of children, it was found that the perception of a role does not automatically
mean the ability to enact it. On the other hand, there are children who
are spontaneously able to enact a role beyond the degree of perception;
the s (spontaneity) factor is operating.
3. Roles are not isolated; they tend to form clusters. There is a
transfer of s from unenacted roles to the presently enacted ones. This
influence is called cluster effect.
4. There were roles with which the subjects were intimately acquaint-
ed, but still, when put to the test, they were unable to enact them.
5. The set of roles considered pertinent varies in the two projects,
A and B, studied. The results indicate that anthropological studies will
profit from comparing the findings of role tests given to primitive societies
and to ethnical minorities and ruling groups in our own country.
202
SOCIODRAMA
441
ROLE DIAGRAM
-'MUTUALLY ANTAGONISTIC
: MUTUALLY COMPATIBLE
BIBLIOGRAPHY
1. Florence B. Moreno, "Socioraetric Status of Children in a Nursery School
Group," Sociometry, Vol. 5, No. 4, November 1942.
2. J. L. Moreno and Florence B. Moreno, "Spontaneity Theory of Child De-
velopment," Psychodrama Monograph No, 8, Beacon House, N. Y.,
1944,
3. J. L. Moreno, "Psychodramatic Treatment of Marriage Problems," Sod-
ometry, Vol. 3, No. I, January 1939 ? now available as Psychodrama
Monograph No. 7, Beacon House, N. Y.
4. J. L, Moreno, "Sociodrama," Psychodrama Monograph No. 1, Beacon
House, N. Y.
203
SOCIOMETRIC METHODS
SOME APPROACHES TO GROUP PROBLEMS IN THE BRITISH
ARMY*
J. D. SUTHERLAND, LT.-COL., R.A.M.C. (Senior Psychiatrist: War Office
Selection Boards) AND G, A. FITZPATKECK, MAJOR, RAM.C. (Specialist in
Psychiatry)
The individual workers referred to are:
Brigadier T. F. Rodger, at present Consultant Psychiatrist to the British Army
in India*
Lt.-Col. G. R, Hargreaves, R.A.M.C, Assistant Director of Army Psychiatry.
Lt.-Col. T. F. Main, R.AJVE.C., Specialist in Psychiatry.
Lt.-Col. A. T. M. Wilson, R.A.M.C., Specialist in Psychiatry.
Major W. R. Bion, D.S.O., RAJM.C., Specialist in Psychiatry.
Major S. H. Foulkes, RAM.C., Specialist in Psychiatry.
Major J. Rickman, RAM.C, Specialist in Psychiatry.
Lt.-Col. E. L. Trist, Senior Psychologist to the War Office Selection Boards.
Lt.-Col. H. Bridger, formerly a Military Testing Officer and now commanding a
Civil Resettlement Unit.
In the course of the war, the psychiatrists in the British Army were
confronted with a number of problems which were appreciated by them to
belong to the institution of the army as a whole or to groups within it and
which accordingly could best be treated by methods dealing with the
dynamics of the group in its total setting. These problems were new to
the psychiatrists who therefore had to tackle them without previous direct
experience of what was involved. As successive tasks were dealt with, a
degree of clarification accompanied the increasing and widening experience.
While the measures taken were spoken of at the time as "psychiatric/' it
was realized that the traditional frontiers of psychiatry had been greatly
extended and that the psychiatrists, and the psychologists who later joined
them, were in fact in new roles in relation to the groups they were treating.
It was later recognized that this independent development had features
in common with certain trends in America where the term "sociatric"** has
*This report has been passed by the British War Office Public Relations Depart-
ment for publication. Because of the hasty conditions under which the paper had to
be prepared, it does not purport to be more than a preliminary report.
It is planned to release the fuller statements in SOCIOMETRY at a later date.
**See J. L. Moreno, "Who Shall Survive," p. 192; also, Soriometry, Vol. VI,
No. 2.
205
443
444 GROUP PSYCHOTHERAPY
been introduced to describe measures of this kind for group problems. It
is as yet too soon to describe these developments fully but it is hoped that
the various workers concerned will do this in due course. The purpose of
the present article is merely to give a very brief indication of some of the
group techniques used and some of the considerations leading to their intro-
duction. The present authors have been engaged chiefly in selection prob-
lems with the result that these are dealt with more fully.
At the outbreak of war a Consulting Psychiatrist (Brigadier J. R. Rees)
was appointed to the Army and early in 1940 he selected a team of psy-
chiatrists to develop a psychiatric service for the Army. These psychia-
trists had all been engaged in psychotherapeutic work with the neuroses and
shared a dynamic psychological viewpoint largely deriving from psycho-
analytic thought. Most of them were also interested in the wider social
aspects of the neuroses and their prophylaxis. It is difficult to state what
the particular contribution of this background was in determining the steps
taken by the Army psychiatrists, but it probably made it easier for them
to evolve, as they did, therapeutic procedures applicable to the institution as
a whole, and in the evolution and operation of these procedures, to seek
from the start the participation of the "lay" members of the institution in
an active way. For what characterizes effective analytic treatment is
the active participation of the patient in working out its rationale.
The General Service Scheme
One of the first instances of a procedure to deal with a problem of the
whole institution was the General Service Scheme initiated largely by
Hargreaves. The basic aspect of "the field" in the early stages of the
war was that Britain was faced with the necessity of building up with the
utmost rapidity its fighting services and its war industries. In the resulting
competition for man-power no individual could be rejected from the Army
unless it was clear that he could not be employed in any capacity- in it.
It had been expected that there would be psychiatric casualties arising
from the stress of active service but what had not been foreseen was the
extent of the psychiatric breakdown rate during training amongst those who
had no experience of action. It became apparent that one of the most
important causes of difficulty in adjustment to the Army was unsuitable
employment within the Army itself. A large number of soldiers were occu-
pied in work which was either above or below their capacity and, in either
case, dissatisfaction, poor morale and even breakdown were apt to follow.
206
SOCIOMETRIC METHODS 445
The value of selection tests was well known to the psychiatrists who, as
well as some civilian psychologists, had carried out experiments with these
in the Army, But the nature of the situation was such that it could be
met only by introducing measures which effected a radical change in the
field and in addition satisfied certain specific requirements of the field.
These were that the measures should be acceptable to the psychologist in
that his participation was scientifically adequate, to the Army in that its
representatives preserved their executive roles and contributed their experi-
ence, and to the recruit in that techniques used should appear relevant
to his situation. These aims were achieved by setting up a Directorate for
the Selection of Personnel to be responsible for the General Service Scheme.
The Directorate was controlled by a senior Army officer who had as technical
advisers for the task of creating a selection machinery psychiatrists and
psychologists, the latter being given military appointments for this purpose.
There were few qualified psychologists available and after the general plan-
ning was completed, most of their time had to be devoted to the creation of
suitable tests. To operate the scheme, with the large numbers of recruits
involved, regimental officers were selected and trained as Personnel Selection
Officers whose function was to use the results of the selection tests along
with the data from interview of the recruits and on the basis of the findings
to decide for what kind of job in the Army each recruit was suitable. The
Personnel Selection Officer referred certain problem groups (e.g., those of
low intelligence) and any individual problem cases to a psychiatrist for
special advice on disposal. The operation of the scheme involved a change
in the structure of the Army. Previously enlistment had taken place
directly from civil life into the various infantry regiments and other corps.
It was determined partly by the individual's expressed preference and
partly by the demand situation of the various arms at the time. Under
the new scheme, Primary Training Centres were set up into which all recruits
were enlisted. There they received basic army training in the course of
which the selection assessment was made. Hence the recruit's first con-
tact was with the Army as a whole and not with a particular branch of it.
Further, the fact that one of the first actions of the Army in its contact
with the recruit was to study him seriously with a view to finding out
how he could best be employed, made the whole procedure relevant and
acceptable from the recruit's point erf view. The result was that the measure
not only had a prophylactic value in the sense that it tended to reduce the
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446 GROUP PSYCHOTHERAPY
incidence of unsuitable employment as a cause of disability, but also a
therapeutic value in its effect on general morale.
The fact that the General Service Scheme with its extensive use of
psychologists and psychiatrists is now taken for granted as part of the Army
is evidence of its effectiveness in dealing with the problems for which it was
devised. There would seem to be little doubt that his acceptance has been
secured not only by the adequacy of the selection techniques, but by the
satisfying nature of the participation which the scheme has permitted to
all parties.
Officer Selection (a) Evolution of an acceptable scheme
The General Service Scheme applied to Other Ranks only, but the
situation at officer level had also become unsatisfactory. The rapid ex-
pansion of the Army and the increasing proportion of officers required by
the needs of mechanized warfare had demanded a vastly increased supply
of officers. Under this demand, the system which had been in use for
officer selection showed signs of breaking down and steps had to be taken
to remedy this. Army psychiatrists had, by this time, accumulated a fund
of experience on officer problems so their opinion was again sought when
the question of improving the quality and quantity of officer supply became
acute. Again the job of the psychiatrists engaged in this work was to forge
an instrument which was part of the Army in that it made full use of
both the experience and the traditions of the Army and of the resources of
the psychological sciences. It would have been possible to construct a
scheme for officer selection in which psychologists and psychiatrists applied
their methods to the problem while the Army made use of their results,
but to do so would have been to introduce a "foreign body" into the tissues
of the Army which would have provoked an inevitable defense reaction.
This would have made the selection task much more difficult to begin
with and impossible eventually. It was considered, therefore, that the
Army itself had to be fully responsible for the solution of this particular
problem and that the instrument of selection evolved should be of such a
nature that the Army could demonstrate its acceptance of this responsibility.
The task of the psychiatrists then was to work within the framework of
the institution and, at the same time, to educate the institution itself so that
the method evolved should both spring from it and influence it.
The solution which resulted from this situation, largely the work of
Rodger, was the War Office Selection Boards. A W.O.S. Board can be
208
SOCIOMETRIC METHODS 447
defined as a military group whose function is to make an assessment of
personality in either officers, or applicants for commissions, with a view
to determining their suitability for various officer roles in the Army* It
consists of a President and Deputy President, Military Testing Officers,
and a Psychological Department which has a psychologist and a psychiatrist.
The President, who is a senior Army officer with wide experience of the
Army, is responsible for the decisions made by the Board. In his executive
capacity he represents the Army to the candidates and in the eyes of the
Army he acts as a guarantee of the procedure. The Military Testing
Officer is a regimental officer usually with experience of battle conditions,
who is more nearly contemporary in age with the candidates. He has a
dual role in that he has not only to observe and assess the candidates' per-
formance on certain tests, but also to look after them throughout their
stay at the board. The psychiatrist's function is also twofold. He is the
medical examiner who assesses the candidates from the point of view of
psychological fitness for the officer role and his medical status assures the
candidate that his examination will be conducted without prejudice. He is
also the scientific adviser to the President in the evolution of test proce-
dures, and in this role he works in close cooperation with the psychologist.
The details of the testing procedure used are not relevant to this
article but two group techniques might be mentioned which are prominent
features in it. The first of these was introduced in connection with the
assessment of one of the most fundamental aspects of officer suitability,
namely, the quality of the individual's social relationships. Bion formulated
the view that one way to assess this was to put the candidate in a setting
where the quality of these relationships was tested in a psychologically
direct and real situation and for this purpose he evolved the method of
"Leaderless Groups." He stated the principles underlying this method
as follows: "The Leaderless Group Tests are intended to display to their
fullest extent those general qualities of personality that are of equal value
or of equal danger whatever the duties their possessor is engaged in. These
qualities are displayed in the interpersonal relationships that form a
marked feature of the Leaderless Group Tests. The function of these
general qualities that are observed is best described by the psychiatrist's
use of the word 'contact/ that is to say, the capacity for mature, inde-
pendent social relationships."
These tests are applied to candidate groups in whom the optimum
number is eight* To be brief, the method consists in presenting to the
209
448 GROUP PSYCHOTHERAPY
group a problem of some kind, verbal or practical, and leaving the group
entirely free to work out its own solution. The merit of the method is that
it forces the candidate to make some revelation of the quality of his social
contact by making use of his anxiety to do well for himself. In individual
tests the candidate's desire to do better than other candidates presents no
problem but when the testing officer puts him through his test as a member
of a group without a leader and not as an individual, a problem is intro-
duced. The anxiety to look after his own interest remains but the testing
officer has given an instruction which calls into activity not individuals but
a group formed by those individuals. Moreover, he has giVen no indication
whether he means to judge the performance of individuals or the per-
formance of the group as a whole. A conflict therefore arises and the
candidate finds that he can only demonstrate his abilities through the
medium of others, and this being true of everyone in the group a common
purpose is created, namely, so to act to one another that each individual
will have an adequate opportunity to display himself. The Leaderless Group
method, therefore, sets two types of problem:
(i) the real or social problem, that is to reconcile group purpose with
individual aspirations, and
(ii) the quasi-real, or set problem, that is the particular test situation.
The real problem is only sensed by the candidates, it is concealed by the
operational problem which is set and to which the candidates direct their
attention. From the point of view of the observers, it is the real problem
which engages attention. Their task is to identify what is spontaneous in
the behavior of the members of the group and through this to get some
indication of their "group cohesive" and "group disruptive' tendencies.
The need for the second group technique largely arose out of the
situation created by the use of the Leaderless Group Tests. At the W.O.S.
Board each candidate is judged by three observers, President (or Deputy
President), a Military Testing Officer, and a Psychiatrist or Psychologist.
Originally the observers worked independently during the testing period
and met to pool opinions at a final conference. It was difficult in practice to
maintain strict independence under these conditions. The President and
Psychiatrist had interview roles only and there was created in them a cer-
tain "tension" because they lacked the opportunity of seeing the candidate
in action a source of data they need to make a rounded judgment. On
the other hand, the Military Testing Officer experienced a corresponding
need to have data about the life-history of the candidate in order that his
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SOCIOMETRIC METHODS 449
"cross-sectional" view which he obtained from the practical tests could
be properly interpreted. Further, at the final conference discrepancies could
not always be resolved to the satisfaction of all observers because one or
other felt in these cases that his "judgment' 1 had been deemed "wrong"
without what was to him sufficient reason. To remedy this situation it
was thought that what was needed was a method of "socializing" the judg-
ment process. In brief this was achieved by combining the three observers
into an observer team whose task was to reach group judgment. The team
now begins this task by considering certain evidence in common. Each
member is provided with relevant data about the candidate's background
and then the team observes a series of Leaderless Group Tests early in the
Board procedure. At the end of this series a "query conference" is held
at which the members of the team interchange freely initial impressions
of the candidates. This interchange enables the group to make alternative
hypotheses about those candidates on whom there is a difference of opinion
and then to decide which member of the team is likely to obtain evidence
that will be critical. From this point in the testing program each member
occupies his specialist role as an investigator, the President and Psychiatrist
or Psychologist as interviewers and the Military Testing Officer as an ob-
server of further special test situations. At the end of the testing pro-
.gram there is a further interchange of judgments and then each member
makes his report independently for a final conference at which all the
evidence is considered. The observer team with its definition of roles for
each member has largely dissipated the tensions referred to previously and
reduced the danger of unsatisfactory roles creating inter-personal relation-
ships between the judges which adversely affect the judgment process.
Officer Sdectionr(b) Candidate Supply
As indicated earlier, the problem was not only improving the quality
of officers by suitable selection methods, but also that of improving the
actual supply of candidates for commissions. The usual method of applica-
tion was for the candidate to be recommended for a commission by the
Commanding Officer of his unit, but a survey of sources of supply carried
out by Trist showed that some units put forward far more candidates than
others and since there was no reason to suspect such wide differences in
quality between these units, it followed that the possible sources were not
being fully tapped. Bion suggested that use might be made of the knowl-
edge which any group possesses of its own resources and, to mobilize this
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450 GROUP PSYCHOTHERAPY
knowledge effectively, the men in good units might be awarded the privilege
of nominating candidates to appear before the W.O.S. Boards. Trist (who
had entered the Army after the start of the W.O.S. Boards pointed out
that this was in fact a real sociometric procedure and he suggested that
sociometric methods should be employed.
The participation of all the relevant authorities was secured and an
experiment was put into operation along these lines. A number of units
were chosen by an Army Commander varying in size from Infantry Bat-
talions down to isolated companies, but each composed of a number of
small functioning units, e.g., platoons in the case of Infantry. At a specified
time each complete unit was paraded and all members of it were asked to
write down on a piece of paper the names of all those whom they felt
were suitable candidates for commissions. It was explained that they should
be sure to choose good candidates because it was quite likely that in due
course some of those chosen would return to the unit as officers. Choice
papers were completed anonymously with the men, the senior N.C.O.'s, and
the junior officers working in independent groups.
From the result, various choice patterns were worked out. For each
individual nominated it was possible to compare the choices he received
within his own platoon, those originating from outside his own platoon,
but from the same Company or Battalion, those originating from N.C.O.'s
and those originating from officers. Finally, the Commanding Officer gave
his own list and his opinion on all the nominations. The results obtained
were on the following lines:
A few soldiers received outstanding suport from all sources. Then
there was a break followed by a much larger number of soldiers with less
support or with support confined largely to one category, e.g., a man might
be strongly supported by his own companions within the platoon but not
outside it and not by N.CXVs or officers. It was decided to call up for
examination by a W.O.S. Board all those who had received an appreciable
measure of support from any source. From this it became dear that many
of them had received support largely because they were regarded by their
own companions as group leaders in those problems which the men felt
to be their own. An appreciable difference in the quality of the social atoms
of many of these candidates was noted. In many, an apparently negative
attitude to authority had been determined entirely by the field in which
they were placed and did not reflect any unsuitable basic personality trends,
A number of these did not want commissions when they arrived at the
212
SOCIOMETRIC METHODS 451
W.O.S. Board but changed their minds when the misconceptions and the
negative attitudes based on these were dispelled by their experience at the
Board where the usual barriers between officers and men are much more
permeable.
The conclusion was that this method of selecting candidates produced
a number who would not under ordinary circumstances have appeared at
a W.O.S. Board, and that of those many were quite suitable for commis-
sions. A more extended trial of the method was planned but it was not
possible to carry it out for various reasons, one of which was the fact that
the introduction of the W.O.S. Board procedure had, in itself, largely solved
the problem of supply. Its fairness as a method of judgment had made a
wide appeal and had largely removed the doubts and hesitancies which had
been interfering with the flow of candidates.
Training
The intensive study of personality, which was intrinsic in the work of
W.O.S. Boards, focussed attention on certain specific problems. One of
these was the problem of immaturity. Boards were constantly being faced
with candidates in the 18 to 22 age groups who gave the impression that
in time they would be suitable officers but that they would require more
development than would ordinarily take place during a course at the Officer
Training School An attempt was made to deal with this problem by setting
up a special training centre, to which these candidates could be sent for
a course of intensive training lasting some 10 weeks. The idea was that
this should develop their self-confidence and accustom them to the idea
of responsibility, and that after the completion of this course they should
be re-assessed by another W.O.S. Board to see whether they had developed
sufficiently to proceed to Officer Training School.
At this training centre each intake was divided into platoons and these
into sections, the initial division being purely on a random basis. At fort-
nightly intervals during the training period a sociometric test was carried
out by sections throughout the whole intake, each student being asked to
rank those in his section, putting the one whom he considered would make
the best officer at the top, and the others in order down to the last, or the
least likely to make a good officer. In addition, the student was asked to
write down briefly the reasons for his choice in the case of the first and
the last. The results from these tests were used to reform the sections and
platoons, the best being put into erne platoon, then the intermediate into
213
452 GROUP PSYCHOTHERAPY
another, and finally the low ranking into a third. The result was that at
the end of the training period, what could be called a "creamed" platoon had
separated out, containing in it all students who had been effective in their
groups from the beginning of the course, and similarly at the other end.
Further, by comparing the rankings achieved by each student throughout
the course, it was possible to get a fairly clear idea of his progress and
relationship with the others. The value of these results to the W. 0. S.
Board which saw the student at the end of the course does not require to
be stressed; but an interesting point which emerged was the fact that the
changeovers became less and less difficult. The resquadding after the first
sociometric test usually resulted in a difficult period, but after the second
and subsequent tests adjustment was much more rapid. By this method,
students tended to find their own level, and by the end of the course a
situation had been created in which no student was overshadowed by any
of his immediate associates.
A similar technique was employed at another training centre, the pur-
pose of which was to give infantry training to those who were applying for
commissions in infantry but who came from other arms of the service. Since
this centre provided a set course of training the results of the fortnightly
sociometric testing were not used for resquadding. The students remained
in the same groups throughout their course with the result that the socio-
metric tests enabled a progress chart to be made of the status of each
individual in his own group. At the end of a weapon training course lasting
six weeks there was a further three weeks' battle training of a much more
strenuous type. The effect on ranking which this change produced was often
highly informative,
One of the most interesting and instructive investigations carried out
during a training period was a study of platoon life by Main. His approach
to this was determined by his experience of the Leaderless Group technique
and in his study he applied both sociometric methods and leaderless group
methods. This involved giving the platoon a number of different jobs to
do and watching the spontaneous groupings which formed as well as inves-
tigating the groupings which took place in the barrack room and off duty in
the canteen. To this approach Main added the use of sociometric tests
and personality studies of the group members by means of psychiatric
interviews.
214
SOCIOMETRIC METHODS 453
Group Therapy for the Neuroses
The study of leaderless groups at W,O.S. Boards led Bion to the con-
sideration of the possible application of group methods to the treatment of
neurosis as a social problem in the Army. In collaboration with Major
J. Rickman, R.A.M.C. he carried out a study of the possibility at a military
psychiatric hospital. Pointing out that the term group therapy could
refer to the treatment of a number of individuals assembled for special
therapeutic sessions or to a planned endeavor to develop in a group the
forces that lead to smoothly running cooperative activity he used this latter
conception to work out his treatment program. His object was to deal
with the situation by attempting to display neurosis as the real problem
of the group and one which would be worthy of communal study and attack.
He felt that if the recognition of neurosis as a common enemy were achieved
then the group would discipline itself to deal effectively with the common
danger. With this object in view he concentrated on the development of
groups in the training wing of the hospital. He stipulated that each man
had to be a member of one or more groups designed to study handicrafts,
Army correspondence courses, carpentry, etc., but any man could form a
fresh group if he wanted to do so either because no group existed for his
particular activity or because for some reason he was not able to join a
similar existing group. A parade was held each day at a fixed time lasting
30 minutes. The ostensible object of this was that it provided an oppor-
tunity for making announcements and conducting other business, but the
real intention was that it should develop into a therapeutic seminar, e.g.,
providing an opportunity for free discussion and eventually self-criticism.
Early in the experimental period groups were formed readily, but it
became apparent at the same time to both the Psychiatrists and the patients
that very little was happening. The freedom granted to the group for
spontaneous activity began to cause no little anxiety in the patients- A
small proportion complained that the large majority merely took advantage
of the freedom to do nothing and that no steps were being taken to stop this.
Bion took the view that their concern over the social effects of neurotic
behavior must be turned into constructive action on their part, and pointed
out to them that the presence of uncooperative individuals in a society was
one they had already discussed in general terms and that they had realized
then that punishment of the kind they wanted imposed had not solved
the problems. He therefore suggested that it was up to them to study the
215
454 GROUP PSYCHOTHERAPY
problem more fully and then work out a solution. Being confronted with
the reality in this way of neurosis as a problem of their own group led
to a reorientation of their outlook towards the problems of their own illness
and an interest in the general morale.
Bion and Rickman were unable to continue these very important
experiments of which they have given a brief account.* Following on
this start, however, an attempt has been made by Main and Bridger to
make a Military Psychiatric Hospital a field in which the neurotic patient
can create new confidence in himself by learning to take part happily in
the give and take of autonomous group activities through an increasing
insight into, and toleration of, the psychological limitations both of himself
and others. With this has been combined psychoanalytically based group
psychotherapy evolved by Foulkes.
Civil Resettlement Units
When prisoners of war began to be repatriated their adjustment prob-
lems were investigated by Bion, working with officer repatriates, and Wilson
with other ranks. It was found that practically all prisoners who had had
a long period in captivity developed difficulties in adjustment to their new
social field and it was dear that, unless something was done, these diffi-
culties would create a serious problem when large scale repatriation occurred
at the end of the war with Germany. There have now been established
for these prisoners returning to civil life a number of Civil Resettlement Units
run on principles worked out by Wilson, Trist and Rodger. In brief these
Units constitute a transitional community in which the individual learns to
change his adaptations to the captive community into attitudes which make
for more successful tackling of the free conditions of civil life. Attendance
at these Units is voluntary and the soldier may remain there up to three
months. During his stay he is paid by the Army and his release from the
Army does not become effective until the day he leaves the Unit. The Units
are run by carefully selected military personnel and the living conditions at
the Unit are made as attractive as possible. The only parade is the pay
parade and from the start the soldier is introduced to the activities of civil
life while still enjoying the security of the group. Frequent discussions of
a free character are held in which all kinds of common problems can be
ventilated. Visits to factories etc. are arranged and local representatives of
*"Intra-Group Tensions in Therapy Their Study as the Task of the Group."
Bion and Rickman. The Lancet, Nov. 27th, 1943, page 678.
216
SOCIOMETRIC METHODS 455
industry and of the Ministry of Labor give talks at the Units and answer
questions. The soldier may even work at a factory for a time to sample for
himself a particular job before he derides his future. Trained social workers,
vocational psychologists, physicians and psychiatrists are available to him
in the elucidation of his problems but the fundamental working principle is
to create conditions so that he makes use of all the facilities spontaneously.
It is as yet too soon to conceptualize the rich experience being gained in these
Units in various problems in social psychology. Already, however, it seems
that after the initial pleasure a phase follows in which the anxieties aroused
by the imminence of freedom make the individual test out rather critically
the sincerity and genuineness of the efforts of the Unit staff. There tends
to be a somewhat agitated demand for control or discipline to be imposed
by the staff but when that is refused he begins to accept the realities of
his position for himself. There is then a great deal of constructive develop-
ment unless the effects of his experience have reinforced previously estab-
lished internal barriers to free social locomotion. In such cases the help
of the Psychiatrist is usually sought. The experience in this type of Unit
is not only valuable from the point of view of the repatriated soldier making
his new adjustment but also in relation to the attitudes of the members of
the group into which he is growing. A great deal is being learned about
the anxieties and tensions created in all parties when a group is given con-
ditions for free democratic development.
The account of some of the approaches to group problems has perforce
been rather sketchy. Much fuller statements will be required to do justice
to them. The authors would like to mention in conclusion that the treat-
ment of group problems such as those described has been accompanied
by a marked group development on the part of the psychiatrists and psy-
chologists involved. It has therefore been difficult to attribute work to
individuals for so many of the approaches have emerged from consideration
of the problems by a group. Projects have tended to be handled by varying
sub-groups yet there has remained a remarkable feeling for the group as a
whole with the result that none of its members has tended to think of any
particular contribution as his own though in fact, he may have played the
leading part. The group, of course, has also had the invaluable contributions
of many Army officers. As stated at the beginning it is hoped that fuller
statements will be written later.
217
THE WARMING UP PROCESS OF AN AUDIENCE
PAUL CORNYETZ
Psychadramatic Institute, New York City
I. THE GROUP AND THE AGGREGATE
The group is not achieved through the mechanical addition of person
to person, nor is the group simply a matter of persons being spatially close to
one another. Persons belonging to the same profession do not necessarily
constitute a group by virtue of the stated similarity. A structure of inter-
personal relations exists among psychologically proximate individuals and
this structure is not reducible to any elements, units, or other "bits of
psychic stuff," When people engage in related activity or work toward a
common goal in inter-awareness, they create a group. Furthermore, a group
is a process and not a thing. It is possible to imagine a number of persons
remaining in proximity who will not develop inter-relations, but no common
activity nor goal can have been introduced. In such an instance it would be
better to speak of an aggregate of persons. The initial problem of group
psychotherapy is the development of a group out of an aggregate of persons.
The word "group" tells us that each individual has emerged as a person with
membership position in a network of interpersonal relations. Each person has
a role relation to his fellows and a status in the hierarchy of roles in the
interpersonal structure. Thus the individual of the aggregate becomes the
person of the group, related to other persons by an activity or goal.
Aggregates exist as transition phenomena one group is dissolving and
in its stead another is organizing. This is generally equivalent to saying that
the function common to the involved persons is changing. "Function" is an-
other way of saying "structure" and not an opposing term. The function as a
separate term identifies the activity over which the lines of organization es-
tablish. The structure as a separate term identifies the positional aspects of
real individuals (and not as is sometimes stated, abstract forces converging on
abstract persons). Finally, a group is a structurofunctional process in time.
These considerations lead us directly into the problem of the wanning up
process.
218
456
SOCIOMETRIC METHODS
457
1. The inactive
spectator.
3. The participating
spectator.
x
4. The participant actor.
2. The active
spectator.
X
One of the important aspects of the
psychodramatic session is the problem and
process of wanning up die inactive spec-
tator to full and beneficial participation.
Warming up is always a two way affair
in any session.
The reactive spectator becomes finally a
participant actor T helping to organize the
development of the session.
In group psychotherapy, the director
is always aware of the degree and the
stage of warming up in his group of pa-
tients. The degree indicates the efficacy
of the technique in use. The stage indi-
cates the condition of the disorder in terms
of the amount of s- (spontaneity) factor
readiness.
r
r~
II, GROUP PSYCHOTHERAPY* AND THE WARMING UP PROCESS
The director of a typical psychodramatic session has as his initial
problem the warming-up of his audience. This same problem is encountered
*In this chapter some of the techniques are described which J. L, Moreno uses in
psychodramatic sessions.
219
458 GROUP PSYCHOTHERAPY
by the therapist who must develop a group out of an aggregate of patients.
Acting as demonstrator of techniques in sociometry, sociodrama, or psycho-
drama, the director is in an easier position. The topic arranged for the session
provides him with the solution. Around it as a guiding principle, he en-
courages the development of a group. Out of the way in which the inter-
personal relations structure between members of the audience, the themes
of activity arise. These themes are projected on to the stage through those
individuals who have warmed up to the degree of readiness (spontaneity)
required for impromptu presentation.
The usual techniques for the warming up of an audience are familiar.
The introductory talk is used most often for this purpose. As a sociometric
technique, the introductory talk is not so much an opportunity for the
speaker to express his convictions or to defend his evaluations as it is
the opportunity to awaken the interest of the audience, to arouse contro-
versial attitudes and private memories. This process of awakening develops
to the point where a number of the spectators are eager to present their
attitudes and memories on the stage. The group has begun formation.
According to the manner in which the speaker phrased his comments, these
individuals have begun to relate themselves either to the issues involved
in the comments or to the speaker. The director, in other words, may en-
courage the audience to organize with respect to him as a carrier of certain
viewpoints or with respect to the issues. Generally the latter procedure is
more effective from the point of view of the group. The former is an instance
of focussing transference upon the speaker.
By the end of the talk, each person in the audience should be awakened
to his individual viewpoint. Already there will be some in the audience who
are ready to activate their own attitudes by entering impromptu situations
on the stage. These first situations mark the completion of the warming up
of the audience and the start of the session proper. Henceforth the process
of activation furthers the structuring. The presentations of private view-
points on the stage delineate with progressive clarity the lines of organiza-
tion.
The participant actor (or auxiliary ego) is a powerful tool of the direc-
tor in accelerating the wanning up. He aids the subject in the latter's
presentation and provides the director with the opportunity to interpolate
specific attitudes and behavior patterns. These may contrast with those of
the subject and so give them sharp relief. Again, they may stress and un-
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SOCIOMETRIC METHODS 459
derline the subject's actualized attitudes. Finally, the trained participant
actor involves the subject so fully in the thematic development that deeper
attitudes are aroused and brought into objective focus. Returning to the
audience, this person has emerged as an individual to the rest of the members.
With succeeding presentations, the roles of the audio-egos continue to be
clarified in their relations to each other.
The director may not begin with an introductory talk however. Another
approach which is more individual-centered has been used frequently. At
random, he selects someone from the audience to join him upon the stage.
In an informal, mutual interview, the director gains insight into the per-
sonal world of the subject. But, more important in the immediate sense,
he discovers the subject's range of acquaintance with the other members of
the audience. Using the topic of the session as the tool, he finds out what
the subject's viewpoint is and how this viewpoint compares with those of his
acquaintances in the audience. Thus the subject begins to define his own
role relations to those other persons, with respect to the topic. This role-
definition through implications tentatively outlines the roles of the others.
As the subject warms up to the mutual interview, bringing out more
detail, involving more issues, the strangers in the audience develop an
awareness of their own attitudes. The spheres of role-relation widen and
incorporate more and more persons in the audience until finally each one
perceives his relations to the subject on the stage and to the subject's
acquaintances. In a real sense, the acquaintance volume of each audio-ego
has expanded to include these persons.
The mutual interview ends with the subject entering an impromptu situa-
tion which has grown out of the role-definitions. The participant actor may
be selected from the director's staff or may come from the audience, de-
pending upon the readiness of the individuals. In the total view of the
session, the mutual interview holds the same position as does the introduc-
tory talk. It marks the end of the warming up of the audience. The mem-
bers have become related. One advantage of the mutual interview over the
introductory talk is that in the latter the director must be careful to call
attention to the issues he has verbalized rather than to himself as a protago-
nist of certain attitudes. Another advantage is that the mutual interview
maintains the issues as concretely located in a member of the audience
rather than in the abstraction of the issues themselves. These advantages
alone render the mutual interview more effective and more economical in a
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460 GROUP PSYCHOTHERAPY
time sense. An introductory talk incorrectly handled retards the develop-
ment of the group as apart from the director. It may take considerable time
for the audio-egos to discover their relations to each other rather than their
relations, as separate persons, to the director. On the other hand, the ex-
pertly handled talk will be fuller in scope than the report of any one sub-
ject drawn from the audience. The specific needs of a situation determines
which method is best suited and no rules are possible as yet.
The group psychotherapist is similarly confronted with the problem of
encouraging the development of a group out of the aggregation of patients,
But he has no ready solution in the form of a topic for the session. He must
discover the principle of organization within the aggregate itself. This prin-
ciple has to be at once natural to the involved patients and therapeutically
useful. Conveniently, however, he can select the patients who are to go into
the aggregate whereas the director of an educational demonstration accepts
whoever comes to the session. This convenience can be used to set the scene
for organization.
The therapist may decide to aggregate patients with similar syn-
dromes. An audience of alcoholics is readily approached with the theme of
initial addition to drink, for example. It is possible for the aggregate to
develop into a group even where the syndromes are not related. Patients may
be brought together because their case histories indicate similar "psychic"
trauma or similar etiologies. It will be more difficult to encourage group
organization at the outset with this arrangement, but it is a question for
experiment whether or not such a procedure may enrich the individual
patient's comprehension in the end. Obviously, the haphazard aggregate with
which the director is faced is not advisable for the therapist.
The introductory talk is of less value and is more hazardous in group
psychotherapy than it is in educational demonstration. To encourage the
patients to develop transference to the therapist considerably limits group
structure. Far preferable is it to encourage inter-relations among the audi-
ence members, for it is almost a certainty that individual transferences to
the therapist will occur. Again, the therapeutic session initiates at a deeper
level than the educational one, and for this the mutual interview is dearly
superior. Work on the social level does not have to activate the recesses
of personality as much as psychotherapy. The mutual interview goes further
in familiarizing the patients with the impromptu process and gives a con-
crete psychological climate to the session. Finally, the mutual interview gets
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SOCIOMETRIC METHODS 461
down to work immediately, eliciting material for the first situations. The
individual-centered approach of this technique opens up not only the ac-
quaintance volume of the subject but also moves into his personal world or
social atom. The relative importance of these two areas reverses: the edu-
cator is more interested in the acquaintance volume as a starter and works
into the social atom later on; the therapist prefers to activate the personal
world as soon as possible, using the facts of acquaintanceship as an audience-
directed technique. These facts may become a discussion focus between
situations. It is of greater importance to utilize the reports of the
personal world as group structuring devices since they simultaneously func-
tion in the therapeutic process.
The importance of the auxiliary ego is impossible to over-evaluate.
The entire process of group psychotherapy depends upon the skilled use of
the auxiliary ego and upon that person's own resourcefulness and experience-
range. The warming up process is an especially delicate procedure. It is
familiar to us that patients readily identify with figures verbally presented
to them. This mechanism is even more striking in group psychotherapy
where the presented figure is a real person enacting attitudes and experi-
ences similar to those of most of the audio-egos. The initiating impromptu
situations must be, directed so as to encourage each patient to develop his
own readiness to activity. At the same time, mere audience-directed in-
veigling is time-consuming and doubtful in effectiveness, A frequent solu-
tion is for the therapist to begin with simple situations, having aspects com-
mon to all the patients, using the auxiliary ego as an extension of the sub-
ject's ego. As such an extension, the auxiliary ego concerns himself with
the encouragement of the subject's projection and gently guides the subject
into more personal expressions of his behavior patterns.
The similarities and differences between the educator's approach to
the audience in a session of educational demonstration and the therapist's
approach have been suggested in their broad outlines. The director faces a
haphazard audience and encourages structuring along the lines suggested by
the topic arranged for the session. He may start with an introductory talk
or the mutual interview with a person from the audience. As either draws to
its close, the general organization of role-relations has realized. The first
impromptu situations mark the end of the warming up of the audience.
From then on, the roles of those who have worked on the stage as subjects
are enriched with detail. This detail stimulates similar enrichment in each
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462
GROUP PSYCHOTHERAPY
TALK
DIAGRAM II
S = Spectator
D Director
This diagram portrays an audience in four stages of progressive interaction and
integration (1, 2, 3, 4) :
(1) amorphous stage
stage of acquaintance
action stage
stage of mutual relations
(2)
(3)
(4)
audio-ego. The therapist faces an audience whose members have been se-
lected in advance ,in accordance with the group structure the therapist
plans to encourage. He will probably prefer to initiate the treatment
process by the mutual interview because of its individual-centered nature.
The opening up of the personal world or social atom provides the thematic
material over which the structuring of interpersonal relations develops.
Thus the therapist begins at a deeper level of investigation, encouraging
role-relations with respect to more fundamental issues. Both the educator
224
SOCIOMETRIC METHODS 463
and the therapist find the auxiliary ego extremely helpful, the former using
him in the less profound version of participant actor.
III. CONCLUDING NOTE
In sociotherapy the social personality of the person is involved. It
is the public individual in interaction. The viewpoint taken by the director
of the session directs his attention toward the group as structure. A general
catharsis is intended. In psychotherapy the single individual is in the
focus of the director's attention. The subject's personal world of objects,
somantic creations, and role-relations constitute the view. The catharsis
must be thorough, effecting a reorganization of the structure of this per-
sonal world. The private individual 'in interaction is in the focus. Group
psychotherapy combines these two approaches. A combination from the
point of view of the individual cannot be effective. One individual added
to the next is meaningless, The group is made the subject of treatment
and through it, the individuals. This is meaningful and effective.
Whereas in sociotherapeutics the interpersonal relations shape at the
social (public) level, in group psychotherapy these relations must locate
more intimately, involving fundamental issues of the personal world. The
common aspects of the personal world are brought into group awareness and
each member comes to share the same personal world with his fellows. The
treatment then works into the idiosyncratic features of each case, and rapid
generalization of these features through discussion techniques, for example,
maintains a heightened atmosphere of psychotherapy. The catharsis in
action of each individual distributes, as it were, to the others along
the lines of the network organized among them. These distinctions were not
drawn in previous passages because they involve far more than the topic of
the article, but they have a definite meaning in terms of the particular
way in which the warming up process is to be handled.
225
MUSICAL METHODS
THE ORGANISM-AS-A-WHOLE AND MUSIC THERAPY
IRS M. ALTSHULER, M.D.
Wayne County General Hospital and Infirmary, Eloise, Michigan
William White's "organism-as-a-whole" concept is helpful in under-
standing the therapeutic properties of the fine arts. It conceives a human
being as a compact entity, sealed by nature, time and habit even if com-
posed of many opposing tendencies. "Organism-as-a-whole" does not reject
the idea of "mind and body," but relates them as inseparable and having a
common purpose. The viewpoint organism-as-a-whole is particularly en-
lightening in dealing with nervous and mental patients.
Although the arts have never been seriously mobilized for therapeutic
attacks as have herbs, chemicals, electricity and numerous other agents, yet
they made themselves keenly felt in the field of mental hygiene and as use-
ful social vitamins.
The arts, more than other agents, arouse the organism-as-a-whole, not
only because of their aesthetic appeal, but because they accent human ex-
perience. As Dewey says: "In art as an experience, actuality and possi-
bility, or ideality, the new, the old, objective material and personal response,
the individual and universal, surface and depth, sense and meaning, are
integrated- in an experience in which they are transfigured from the signifi-
cance that belongs to them when isolated in reflection." Art penetrates man's
senses and arouses emotions, feelings, the glands and intellect. It affects
his entire past, his rites, ceremonies, his religion, his morale and his con-
duct. The Greeks understood that art reflects the emotions and ideas asso-
ciated with the chief institutions of social life. Plato's demand for censor-
ship of poetry, music and drama shows how strongly they believed in the
influence of the arts upon man.
Always in the vanguard of science, the arts foreshadow human prog-
ress, even in technical endeavor. A substantial number of discoveries and
inventions were vaguely conceived in the fertile minds of poets and writers
long before the blueprints were drawn. The idea of submarine and trans-
atlantic aeroplane slumbered in the imagination of Jules Verne and in the
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465
466 GROUP PSYCHOTHERAPY
story of the "Magic Carpet/ 7 Science, which proceeds more slowly and
cautiously needs the inspiration and prophetic spark of the arts.
Long before Sigmund Freud untangled some of the mysteries of the
mind and conceived the conscious and sub-conscious, Goethe, Nietzsche and
Hartmann with rare insight grasped its workings. Dr. Faust, the con-
scious, and Mephistopheles, the sub-conscious mind, portray the eternal
struggle between the two. The influence of the arts upon man's life and
emotions is no less effective than that contributed by the academic de-
liberations of Freud. By gratifying man's unconscious need for affection, for
aggression and narcissism, they are, in their own way serving a "therapeutic"
purpose. Moreno's dictum: "A true therapeutic procedure cannot have less
an objective than the whole of mankind," becomes more concrete if one thinks
of the effects of the arts.
The arts not only please and enlighten but they assist in relieving emo-
tional tension. In "Brothers Karamasov," Dostoyevski through Mitja not
only relives his own patricidal impulses, but helps vicariously to alleviate
similar impulses in the readers in whose bosoms such impulses may lie
dormant. The introvert, Don Quixote, and the extrovert hypomanic, Sancho-
Panza, foretold Kretshmer's constitutional types.
Music, even more than prose or drama, presents an opportunity for
stifled emotions to find vent, by means of voluminous body rhythm
and motion. Listening to Rimsky-Korsakov's "Ivan The Terrible, 37 for
instance, is bound to have some effect in relieving sadistic impulses, even
if the listener may not be aware of the plot. And one can mourn the death
of a dear friend with less grief listening to "Asa's Death" Mood music
has the capacity to objectify personal sorrow; to shift it into "world
sorrow" which is, of course, easier to bear. The music of Richard
Wagner, who had himself been disappointed in love, provides an example
of this. The groping, morbid, unsatisfied phrases, building towards tremen-
dous climaxes which never arrive, represent extreme frustration, thus pro-
viding an outlet for those in similar situations. Also, happiness and gayety
can be accented by mood music.
The selective action of the arts is the organism-as-a-whole and not that
of a special tissue or organ as is the case with medicaments, viz. digitalis
or pituitary extract, which affect the hpart and water diuresis respectively.
In whatever motive power the arts may reside a product of the uncon-
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MUSICAL METHODS 467
scions, a suppressed sexuality, or an attempt to counteract the fear of nature's
mysterious forces they inspire, socialize and educate.
The arts have always served as a medium for bringing people together
and uniting them. And of them all, there is no equal to music as a cement-
ing force, a force which at once creates unity and intimacy, even in the
most heterogeneous congregate. Racial and lingual barriers, differences in
creed or education are easily surmounted by the musical message. One can-
not hate the one with whom one is singing, provided the voices are modu-
lated to blend. John Dewey's observation that "Art breaks through barriers
that divide human beings and which are impermeable to ordinary associa-
tion" is very applicable to music.
A given composition not only helps to sublimate the instincts of the
composer, but serves a like purpose to the performer and to the listener.
Each may be affected by the same composition in his own way and each
may be benefited to a greater or lesser degree. A talented performer will
deliver the original message of the composer, preserving its emotional con-
tent and meaning so that the listener will get the full impact of it.
Beethoven's statement, "Music is the mediator between the spiritual
and sensual life" finds strong substantiation in clinical observation.
The socialization of the sexual instinct is effected by means of music.
Lower species of animals use brute force to do the work of procreation. There
are female insects which devour the partner in the process of love-making.
Others force coitus by superior strength. Pursuit and capture are gradu-
ally replaced by sexual advertisement, through rhythmic movements (the
dance), sounds and colors. The evolution from killing during coitus, forcing
coitus by superior strength, to luring and inducing it through rhythm and
sound represents quite a progress. Thus the enlarged limbs with which
certain species of Crustacea seizes and holds the female, evolve into the
chirping of the cricket, croak of the frog, the charming song of the night-
ingale, and finally, the crooning of a Sinatra. There is a deep meaning and
strong social impact in music which no doubt emphasizes its therapeutic
significance.
Sound is the principal medium by which most of the higher animals
express and excite emotion. The male bird courting the female, reassures
himself of his ability to procreate and thus further charges his sexual re-
sources and generates pleasure. In many instances, the mating season alone,
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468 GROUP PSYCHOTHERAPY
even in the absence of the female, offers this biological reassurance when
sounds are produced. Singing in courtship makes the goal appear nearer.
The same mechanism is operative in man and is highly significant. He,
too, can socialize his sexual impulses through the dance, vocal chords or
self-made instruments, thus providing emotional relief for himself and safe-
guarding the community from aggression.
Music, the greatest outlet for man's emotions, offers ample opportunity
for the sexual instincts to exercise comparative freedom of action. The ani-
mal instincts, firmly saddled by social, moral and religious imperatives, find
their way out into the open, peripherally, through rhythmical movements
and emotional display. Music and the primitive form of it, the dance, are
nearest to the natural means of sexual gratification.
The behaviour of human beings aroused by "swing" for instance, is
suggestive of coitus. There is dose contact, the embrace, the back and forth,
the "swing" and final exaltation. So near and yet so far, that's the way of
music's action. It furnishes atmosphere and excuse. The value of music
to man is that it offers a "modus vivandi" to the two most bitter and
irreconcilable antagonists, the brain and the spinal cord. This is the chief
reason why music is welcomed and is readily accepted by the church, school
and home.
Music signifies the principles of liberation in the practice of institutional
psychiatry. Mental patients are in fear of and subject to restrictive treat-
ments, often still necessary in overcrowded, understaffed institutions. The
manner in which the patients are brought to the institution differs funda-
mentally from the customary procedures of admitting patients to other
hospitals. A process of legal ostracism precedes commitment. The
therapy that is offered to the mental patients still has the bad odor of
the 17th, 18th and 19th century punishment and restraint. There are
mechanical restraints, chemical restraints and hydriatic restraints. There
is disguised punishment in the electric shock procedure. All these
in addition to the over-powering force of the general mental hospital
regime with its barred windows and locked doors; with its formalism and
often unsympathetic attendants; with the monotony of institutional pro-
cedure where menus, the daily routine and practically all activities are
regimented. The whole atmosphere tends to suppress rather than to free
and expand. Traditions and the weight of organization, as well as public
prejudice, make the task of healing doubly difficult.
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MUSICAL METHODS 469
Music, of all the dynamic arts, is capable of counteracting much of the
fear and restraint inevitable in mental institutions. It disposes of thera-
peutic nihilism. Offering patients an opportunity to "abreact" through music
is a great step toward emotional emancipation and build-up of the ego.
It is amazing to watch mental patients singing and dancing in spite of the
fact that their arms and legs are strapped. Obviously, under the influence
of musical impact, the patients forget that they are in restraint. Listening
to music, and especially singing, makes their minds feel free, just as the
song throughout the dark pages of history has lessened the burden of social-
ly, economically and politically chained people in their daily tasks.
The "Song of the Volga Boatman" provides a socialized way of over-
coming life's exigencies by psychological means, even while tied to the oars.
The Spirituals and Work Songs of the Southern Negroes made life endurable
under very difficult circumstances. Songs like "Steal Away to Jesus" and
"Swing Low Sweet Chariot" not only liberate the emotions and appease
reality, but create hope for a better future. Folk music, both singing and
playing, has a definite function in the practice of music therapy. It not
only reacts on the collective musical consciousness of the race, but through
association recalls happier memories. Its value should not be under-estimated.
Boogie-woogie and jazz are certainly music of the people, and as such have
definite value in mental rehabilitation of patients whose cultural level has
never been raised any higher. The cultured man still retains his animal self
and thus the jazz-brand of music may still affect him. To make a statement
that such music is detrimental would indeed be very short-sighted. On the
other hand, to expect to gain results through such media in treating patients
who have been accustomed to a richer diet of Bach, Beethoven and Brahms
would be equally careless.
The absence of family ties of institutionalized patients presents a prob-
lem which music helps to solve. Music provides a feeling of unity and
belonging. Case after case of uncooperativeness has improved when musical
activities were provided. Attendants inclined to be adverse to any pro-
cedures that might break the prescribed routine, are soon won over when
they realize how music therapy lightens their own tasks. Indeed, the effect
upon the attendants is as important a factor as the benefits to the patients,
especially during these days of limited and over-worked personnel. The
public from whose ranks mental patients are bound to come, feds more
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470 GROUP PSYCHOTHERAPY
reassured knowing that the hospital also provides some of the high cultural
values.
Lately, the group method of treating mental patients and the service-
men suffering from combat fatigue has become the choice method, because
of the time saving and the social impact which it exercises. The
"coherence" of a group depends upon several factors, chief among them a
leader, a goal and emotional currents. A leader is not indispensable a
group can exist on a fratriarchal basis; a goal can be minimized or become
unimportant by changing events. But an emotional current always flows
where there is a congregate of people. It is precisely musk that makes this
emotional flow mighty. In a mental ward music is not only valuable as a
vehicle to group therapy, but as an "appeaser" of the status quo of the hos-
pital atmosphere, as a morale builder, as a source for individual emotional
relief and as a medium of self-expression and ego aggrandisement. In group
singing such factors as inspiration, self-discipline, solidarity and friendship
are cultivated.
It becomes apparent that music plays an important part in the
biological, sociological and cultural departments of life and that it is linked
with propagation, survival, socialization, progress and aesthetics. Possessing
such unusual ingredients, it is astonishing that music's powers have not
been sufficiently utilized in a practical way.
Let's hope, therefore, that in the future the physician, the psychiatrist,
and the music educator will unite in this common cause and bring to man-
kind all the benefits that reside so plentifully in music.
232
MUSIC AS A GROUP THERAPEUTIC AGENT IN THE TREATMENT
OF CONVALESCENTS*
LEILA A. McKAY, Isx. Lx. ; AC
Fort Logan, Colorado
A year ago, authorized experimental work in Music Therapy was
initiated, through the Office of the Air Surgeon, at the Fort Logan AAF
Convalescent Hospital, one of ten convalescent centers under the Personnel
Distribution Command. As a PDC Special Project this work continued under
way in one of the hospital buildings which had been converted for this
purpose. With the help of a capable staff of eight highly specialized en-
listed men, the cooperation of the entire Education Branch and the Fort
Logan Band, activities were carried on to aid overseas returnees and con-
tinental men to rehabilitate themselves mentally, physically and spiritually.
The Music Therapy Program was set up in such a way as to afford
music instruction on any instrument. It also offered diversional opportuni-
ties through the media of the hospital public address system; by supplying
musical instruments for practice and instruction purposes; by making on-
the-spot transcribed recordings either in the Music Therapy building or at
a patient's bedside. There were jam-sessions, song-fests, letters made on
recordings and sent overseas or to folks at home. Some "eager-beavers"
made improvised musical instruments and used them for their own enter-
tainment and enjoyment.
PDC Headquarters sent an expert, the inventor of the "Xylette"
(two and one-third octave, 15-pound, miniature piano), to each one of the
PDC convalescent centers for thirty days to demonstrate how to build the
miniature pianos. These portable pianos were constructed mainly of hard
wood and salvaged parts from the hydraulic system tubing of a B-17. It
was hard to believe or give credence to the fact that music could be played
on aluminum tubing out of an airplane. The results were truly surprising!
The Education Branch opened the facilities of its Tinker Shop and taught
the ambulatory convalescents how to make the parts and assemble the
miniature pianos. We found it took an average of fifty-two hours for a con-
valescent to complete one instrument. There too, in the Education Branch,
*This paper has been cleared through the authorities at Fort Logan.
233
471
472 GROUP PSYCHOTHERAPY
the Woodworking Shop was ready to help ambulatory patients who brought
in damaged wooden musical instruments, in making any possible repairs.
While at Fort Logan, this teacher and inventor, under the direction of
PDC, instructed a group of musicians in the best use of the AAF Training
Manual number 29, called "Sit Down and Play." This manual had been
written especially for use in the Convalescent Training Program by the
person who was sent out by PDC to put the last touches on the various
instructors 7 techniques. Nothing was done haphazardly in the PDC centers.
Short cut, but approved, methods of teaching were promoted by the Music
Section and the Music Therapy Project. It was not uncommon to have
three men sitting at three pianos, with canes or crutches propped along-
side, with their tongues pushing out one side of their mouth, plinking out
"Don't Fence Me In." Within one week of their starting lessons they could
play tunes that other patients could not only recognize but could stay and
applaud.
After the Music Therapy Project's modest debut at Fort Logan with a
xylophone of empty wine bottles filled at varied levels with water, a set
of improvised drums augmented by a snare and bass drum; a set of chimes
built of aviation ball-bearing rings strung on a wooden frame ... and ...
a small group of patients, attendance increased daily.
The first group was made up of the "jammingest gates" in the business.
They beat out rhythms all day long. All of them had been very sick, all
of them were continental men and none of them knew how to read music.
Almost every man who entered the music building did so voluntarily, look-
ing for that intangible quantity called music. Playing it was an emotional
expression and an outlet for pent-up feelings. Hearing it was a satisfaction,
fulfilling a need with a diversional relaxation . . , this was so because Music
Therapy functioned on a voluntary basis. No one HAD to take it. To these
men this music business was strictly "groovy," strictly "hot," and as we
couldn't help seeing . . . strictly diversional. Diversion is a therapy itself,
Without it people go crazy. Music is a part of Man . . . born in him. Down
through the centuries it has never been obliterated or stopped by war,
greed or famine, cash or politics. In this respect it is a stronger power than
Man himself ... and yet, without him, it cannot fulfill itself.
The next group of patients, comprised mainly of orthopedic cases from
the physiotherapy ward, straggled in from time to time, and began to
join the first or "jive" group. Interest began to swing toward building
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MUSICAL METHODS 473
improvised musical instruments and tinkering with the hospital public
address system.
Under the skillful manipulation of the NCOs of the Music Therapy
Project, a broadcasting studio was built and the equipment which is part
of every PDC installation, was housed and presented in such a manner as
to look like a reasonable facsimile of a commercial network radio studio.
The entire staff was justly proud of its end-result and christened the studio
by adopting the call-letters "FLCH" taken from the words: Fort Logan
Convalescent Hospital. The therapy value here lay in the point that the
greatest proportion of materials used in building and operating the P.A.
system had been dug out of waste materials and had been utilized mostly
by patient-personnel.
This meant economy, accomplishment, initiative and both mental ajid
physical exercise and stimulation for each participant. Further, these men
were using the knowledge they had learned at AAF specialized schools. They
didn't feel that working in the Music Therapy Project was "sissified" be-
cause they handled familiar war materials which took skill to work with,
and which were a medium for building self-confidence. These activities di-
verted the recovering man's mind from himself and turned the subjective
outlook to that of helping others less fortunate or, as we might put it, to
a more objective trend.
More and more the personnel of the Music Therapy Project was trying
to broaden the patients' perspective and rehabilitate them socially as well 35
physically. Three factors were necessary to "bring back" a returnee or a
sick man whose social-sensitivity had suffered trauma through war experi-
ences. These factors which we believed to be most important were three
perspectives or qualities: 1) the mental, 2) the physical, 3) the spiritual.
These three integral parts were needed to remake a wholesome whole.
All this time the Music Therapy Project, now a part of the recently
organized Music Section, was working with the help of the chiefs of the
specialized medical services in the hospital. These men were the army doctors
in charge of Orthopedics and Physiotherapy, Psychiatry, General Medicine
and Surgery. Under these men it received suggestions for proceeding and
introductions to patients. The Chief of Psychiatry was appointed medical
head of Music Therapy.
Meanwhile, back at the project building, music instruction, lessons
in announcing over Station FLCH and technical use of the controls and
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474 GROUP PSYCHOTHERAPY
radio techniques were being taught to convalescents who dropped in
casually and stayed to learn. The fascination of talking to your buddies
over a microphone and personalizing the P.A. system for those who lis-
tened in bed in the surgery, physio and isolated wards never ceased to intrigue
returnees who had been radio men, bombardiers, tail and waist gunners,
navigators, pilots and mechanics or engineers. But more important, these
same men who had been bed patients themselves were "dishing it out" for
the fun and entertainment of men now confined to their beds.
We realized there was our listening audience to consider as well as our
performers, instructors and pupils. How could we best reach them? What
types of music would have the largest appeal? What music would help them
most? Some of our staff canvassed the hospital wards to engage in social con-
versation those patients who were bedfast; another made posters, program
slips, personal request blanks for filling in and surveying patients' choice, and
originated contests to stimulate through enthusiasm the participation of
these patients who could not leave their wards. Volume controls were in-
stalled on all speakers throughout the wards so that, patients being given
treatments for combat fatigue would not be disturbed by overstrength vol-
ume of broadcasts and yet, other patients could continue listening to music,
variety programs, sports, news and their fellow patients.
The installation and maintenance of equipment* in the wards and of the
PA. system was looked after chiefly by an NCO with civilian radio and
electrical experience. The supervision of the patient announcers and tech-
nicians was handled by an NCO who had been one of the first patients of the
Convalescent Hospital at Fort Logan. Another NCO, also a patient orig-
inally, took over all promotional ward work and devised record systems cov-
ering hours of patient participation, charts, graphs and all pertinent factors
effecting the work of the project. The other NCOs were instructors in
music. Each had been a successful teacher and musician with well recog-
nized professional careers back in that good old civilian era long before
anyone knew there would be another war to win.
Now there are two buildings where instruction is given in music. There
is a record library totalling some 6,000 records of which 1,000 are in a
mobile state, the remaining 5,000 serve as a source of supply to dayrooms,
wards with phonographs, or to fellows who are seeking to complete personal
collections of "platters." There is a music appreciation room equipped with
an electric record-player and another carefully selected library of albums
236
MUSICAL METHODS 475
of classics, both concert and popular. There is the Band Loft where a
convalescent pupil can join a jam-session or practice with other members
of the Fort Logan Band ... or where he can discuss the arrangement
of any music he might compose and where, if it is a good composition, he
will have a chance of hearing the band play it. This is something few of
us can buy, even though we offer to pay for the opportunity in good hard
cash.
Quite recently, under the direction of the Education Branch, new hori-
zons have been viewed through the joint cooperation of the education
program and the music and sound program. We have started making
transcriptions of the voices of convalescents engaged in activities of the
General Speech course offered by the Education Branch. These transcrip-
tions will become an active, audible file by which the convalescent can
gauge his improvement and progress and which will serve as "confidence in
his pocket" should this course be instrumental in overcoming a possible
speech impediment or defect due to nerves. Later these speech course en-
rollees will be given training at the Station FLCH studio in the use of a
microphone and in radio dramatics.
At mealtimes and for a period thereafter, smooth, relaxing, familiar
music is played over the ward network of Station FLCH. We have received
just one complaint from a patient and that in his own words was: "That's a
of a program you've got on!" When we inquired what was wrong
with it, he retorted: , everyone's asleep alia time now and I can't
find me a pinochle partner." So we conclude that on a basis of common
sense, if a person can relax while eating he will benefit from what he eats;
that he will convalesce more quickly. If he can be induced to relax enough
to sleep restfully, he will also be aided toward a swifter and more complete
convalescence. It is to these ends we apply music as a therapy.
All these factors have been used and given a chance to be tried out by
the commanding officers in PDC Headquarters, the Office of the Air Sur-
geon, and most immediately, the Commanding Officer of Fort Logan and
the Fort Logan Convalescent Hospital, and all the "men in charge" at
Fort Logan. The real men in charge are the inner-men within the conva-
lescent patients themselves and it is the other "men in charge" who are
helping give them their chance for recovery and re-discovery of all they had
before the war.
237
NOTE ON PSYCHOMUSIC AND MUSICAL GROUP
PSYCHOTHERAPY
MILTON H. WARD
New York City
INTRODUCTION
From the very first J. L. Moreno has in his writings dedicated himself
to the necessity of a maximum study and use of the spontaneity factor in
all the arts. The drama of life includes, among other things, conversation,
thought, work, play, dance and music. Moreno has at various times devoted
himself to the need and possibility of gaining the utmost use and under-
standing of these in terms of the spontaneity factor. His investigation of
the art of music, his impromptu orchestras, his psychomusic and musical
group psychotherapy experiments have been a most penetrating example
of the wider sphere of his endeavor, A re-examination of some of Moreno's
findings in the music field is lie subject of this paper.
Because it is a poignant and a fluid medium that contains a minimum
of association with the routine patterns of our day-to-day life, and because
it is so varied and universal in its appeal, music is undoubtedly a unique
and important therapeutic agent.
To date, the larger field of music therapy has been devoted to auditory
or passive participation by the subject. Patients attend live or recorded
concerts and find catharsis in the association, atmosphere, or relaxation
which they derive from the music. Accomplishments in this field, especially
in Army psychiatric hospitals in the last several years, have been note-
worthy.
Passive music therapy, however, has persistently posed one primary
difficulty. It has been found invariably among all people, patients as well
as non-patients, that there exists a certain group that have a partial if
not an absolute apathy to music. These are the people whose response is
one of disinterest, and even drowsiness and boredom. Also, even where
there is a definite taste for music, quite often its effect on the psycho-physio
system of the patient has been too superficial to provide any real therapy.
A richer, more moving experience has been desired.
RELATION OF Music TO HUMAN MIND
Before probing this phenomenon, it is well to define the term "music",
and to discover what there is about it that interests the human mind in
238
476
MUSICAL METHODS 477
the first place. Music, acoustically is nothing more than sound frequency
pattern, combined with rhythmic pattern. There are other correlaries such
as tone quality (actually determined by overtone frequency), scale forma-
tions that have been founded in habit and tradition, and volume or intensity.
However, the basic component of music, to which these may only be added,
is the group of sequence of rhythmic (rhythms) tonal frequencies (pitches).
That these rhythm-pitch patterns do have a profound effect on some
of us, that they do indicate that the composer that chose to set them to
paper did express a "gay" or a "disturbed" or a "gracious" emotion at the
time that they were conceived, obviously must be due to some association
between these patterns and the human mind. The answer is to be found
in the fact that the organism also passes through a series of rhythm-pitch
patterns as it travels through the emotional gamut of its existence, and
that the passages played by one or a group of instruments bring these to
mind, (The extent to which this association is exactly identical with the
composer's original state of being is immaterial. A very substantial portion
of the composer's original conception is inevitably present.) The pitch
fluctuation of our bodies is indicated by a greater or lesser tension in the
entire organism, or in any separate part of it, as for instance, changes in
our vocal pitch (caused by greater or lesser tension applied to the vocal
chords), clenching or relaxation of the fists, focusing of the eyes, holding
of the breath, and a host of other symptoms all related to changes in
emotional states. The rhythmic fluctuation of our mobile movements, breath-
ing, heartbeat, rate of thought, etc., represent the rhythmic pattern in our
mood or emotional state. Of course, in somewhat the same manner that
a painting represents a scene, or a word represents an object, the stimula-
tion of emotion by the music media is essentially symbolized.
The fact that certain individuals are entirely unresponsive to music
is due, in the main, to the inability of the individual to mate the necessary
association between personal frequency patterns and those to be found in
the music. Furthermore, those that are capable of only a limited response
to the media, per se are limited in the extent to which they are capable
of making the association. The background of such limited association is
diverse. Many habitually fail to take the time or trouble, or are tradition-
ally uninterested, or find other pursuits more to their liking. Also in our
society, being sensitive to more exalted or complex emotions is in a sense
an expensive luxury. We develop an apathy to anything that is not accepted
by the greater majority of people, because in the business of life one must
239
478 GROUP PSYCHOTHERAPY
hesitate to move out of widely accepted cultural atoms, or face the likeli-
hood of being ostracized from certain professional and social spheres.
ACTIVE Music THERAPY WITH CONVENTIONAL Music FOKMS
A genuine sensitivity to music may be gained or amplified if the subject
indulges actively in music making. Singing, playing an instrument, chorus'
singing, rhythm bands, and even dancing to music are types of active
music therapy. The physical, mental and emotional mechanism are thrown
into a kind of rhythmic frequency activity that to a considerable extent
is similar to the pattern of the music. And in so doing the emotional asso-
ciation becomes intensely apparent. Especially for the person who is per-
forming or interpreting it, music moves quickly to the innermost being.
In addition to hearing the suggested mood inherent in the piece itself, it
offers a sustained and expanding activity sequence which may provide
an effectual catharsis.
However, active music therapy, 35 outlined above, is unfortunately a
very limited psychotherapeutic medium. The mechanical technique in-
volved in bringing an individual or a group to "sound" often exacts so
much in hard, dull practise as to make the result hardly worth the effort.
There is no such thing as music in ten easy lessons. It is an arduous study,
best begun in childhood, which requires years of work for even the most
elementary accomplishment. After a year of steady work at the piano, for
instance, a subject, one with good hands and a good ear, may just be ready
to play nursery-rhyme tunes with some proficiency. And except for children,
this is not very rewarding. Even in an amateur chorus, the grief that a
subject encounters is so painful as to afford little or no time for personal
emotional release. Amateur choruses have a notorious mortality rate
though they often start with enthusiasm. Making music requires extreme
dexterity. It can be compared to the process of learning to talk, though
perhaps it is harder, because we may talk everywhere and at any time.
In addition to the musical alphabet it is necessary to train the fingers
and the ear in the use of instruments far more variable and complex than
even the most complicated lathe from the standpoint of the human element
involved. This requires an automatic motor activity, in an infinite number
of variations, which is almost without precedent in any endeavor. In his
"Creativity and Cultural Conserves With Special Reference to Musical
Expression", 1 J. L. Moreno has made a comprehensive study of the
'See "Creativity and Cultural Conserves With Special Reference to Musical Ex-
pression" in Sodometry, A Journal of Inter-Personal Relations, Vol. 2, No. 2.
240
MUSICAL METHODS 479
infinite difficulty which is to be found in the relationship between the musi-
cian, or would be musician, and his instrumental music making.
Another major difficulty has been pointed out by Moreno repeat-
edly. 2 It is the incessant stifling effect of the cultural conserve that is
inevitably present 'in the music, and never permits it to become a real
vehicle of spontaneous self expression. The catharsis may be remote or even
entirely non-existent in terms of the subject. 3
It is apparent, then, that two primary difficulties must be overcome
in order to gain the fullest benefit from music therapy. First, the rhythmic
frequency association must be sufficiently strong and active to allow the
subject to project himself far enough into the full meaning of the music to
allow for a rewarding catharsis; hence the need for some kind of active
music therapy. And secondly, the experience must not be dulled or over-
weighted by either an inadequate technical prerequisite, or an overdose
of foreign conserve element. It is further apparent, that such a music
expression is possible only if the subject is permitted to create music entirely
within his physical or technical range and within his cultural atom. Just
as we cannot expect individuals partaking in the psychodrama to issue
forth with lines that contain the cultural conserve of a passage from
Shakespeare or Schiller, or to possess the dramatic technique of Barrymore
or Duse, we can hardly expect that an on-the-spot music activity initiated
by the subject, shall in any way resemble Beethoven or Gershwin or shall
be executed with even a remote resemblance to the music produced by
Heifetz or Pons. It must also be remembered that a subject who has no
knowledge whatsoever of music has only himself, his body and his voice
with which to create music, or what Moreno has called psychomusic. 4 And
finally, though we do have a technical and even a conserve structure
around which to build a spontaneous drama (psychodrama) in the speech
intercommunication begun in earliest childhood, almost non-existent use
of the music medium precludes a type of music 5 which is very radically
different from that which we have been accustomed to use in therapy work.
Ibid.
*". . . the warming-up process in a spontaneity test differs fundamentally from
the warming-up process in a musical conserve performance. The one is autonomous,
at least in the moment of production; the other presupposes a successful adjustment
to any synthesis of different egos and minds." Ibid., p. 16.
*See "Creativity and Cultural Conserves With Special Reference to Musical Ex-
pression" in Sociometry, A Journal of Inter-Personal Relations, Vol. 2, No. 2, p. 23.
6 Chapter on "Psychomusic" in Psyckodrama, Collected Papers, Vol. I, Beacon House,
New York.
241
DANCE METHODS
RHYTHM IN MOVEMENT AS USED IN SAINT ELIZABETH'S
HOSPITAL
MARIAN CHACE
American Red Cross, St. Elizabeths Hospital
There is a tendency on the part of certain patients in a mental hospital
to remain motionless and mute for long periods of time, or to move about
restlessly and avoiding contact with other people. Rarely, when left to
themselves, do they gather for group activities. One method used at St.
Elizabeth's Hospital for the encouragement of group activity is through
classes in rhythmic movement.
The writer of this article was asked to try an experimental class in
dance rhythm with a group of women patients in July in 1943, under the
auspices of the American Red Cross which conducts an extensive but
atypical recreation program at the hospital under the direction of the medi-
cal staff. Her previous experience in correcting behavior patterns of
children who were anti-social, and in aiding adults with special personality
problems, not sufficiently pronounced to need psychiatric care, together with
several years of training at the Denishawn School of the Dance and as a
member of their concert company and teaching staff, furnished a back-
ground for the use of dance movement as a medium for group activity with
people not pre-disposed to cooperative action with each other.
During the past three years the number of classes has grown so that
they now cover a large part of the hospital. Many forms of dance are used
on both men's and women's wards. They are graded according to the
degree of illness or convalescence of the patients rather than on the per-
fection of technique achieved by the individuals in a class. A patient starts
in some class when he first arrives at the hospital, whether he is over-active
or confused, catatonic or depressed, and he may continue in successive
classes until he leaves here.
At first, only those movements which can be understood, by visual
presentation or the sense or touch are asked of him. Later through gradual
steps, he becomes able to participate in a formal class in which stress is
laid upon posture, efficiency of action and a conscious group feeling.
On the women's wards and on the wards where catatonic male patients
243
481
482 GROUP PSYCHOTHERAPY
are cared for, rhythmic exercise is used, but on the balance of the men's
wards the accent is placed upon social dancing. It has been found that
many of the men patients at this hospital feel ill at ease on the ballroom
floor, and consequently fail to take an active part in large gatherings of
this nature. Through the class for the practice of ballroom steps, and the
social hours with men too sick to leave their wards, many patients have
gained confidence in meeting new people socially by the time they progress
to open wards.
All classes, whatever the degree of illness of the patients in that par-
ticular ward, are conducted in a circular formation. Hands can be held
around a circle, and a group unity achieved with patients who are too con-
fused to remain attentive without the support of the group. It is possible
in this formation to hold together as many as twenty-five catatonic patients.
In this group they will do rhythmic exercises together swings or arms and
legs, stretching and limbering movements, bending and twisting actions, and
even jumps and trots. These people will stay together while hands are
held around a circle but will scatter into the far corners of the room to
resume their static postures as soon as hands are dropped.
On an over-active ward, group rhythm in a circle is the only form
which will enable the patients to feel free to join the activity for the few
minutes that they are able to stay with a group in the midst of their own
rapid, restless dance patternings. The circle often seems to act as a magnet,
drawing them toward it, when they are too absorbed to speak or to join a
formal class if they were asked to do so. This seems to be a satisfying
grouping to the patients themselves, for they will form the circle for them-
selves, even when they are very confused, if the group leader fails to do
so at the expected moment. While, on a convalescent ward, they will al-
ready have grouped into this formation before the dance director joins them.
By using a method of holding the patients together long enough to
achieve a group rhythm, they are able to move about the room or to stretch
long-unused muscles and gain a purely physical reaction of loss of tension
with a definite improvement in body posture and co-ordination, no matter
how confused and disturbed they may be emotionally, A growing self-
confidence and ease of physical action keeps pace with their convalescence
from their emotional disturbances. As the doctors prepare them to meet
people more easily, they have acquired better equipment with which to do so.
Poise and a lack of individual self-consciousness has many times been
demonstrated by the convalescent patients at the hospital by the ease with
244
DANCE METHODS 483
which they have taken part in style shows and demonstration classes for
large audiences.
The dance director who expects to stimulate strong, simplified but
unified movement in confused, restless, mute or motionless patients must be
willing to be flexible in her approach, and have acquired a technique to
meet their varying moods, in other words, play the role of "auxiliary-ego"
at all times in her contact with mental patients. The mute drama of the
dance may at any point develop into a psychodrama.
It is essential that when a session starts on a ward, where excited
action is in progress, that the leader meet this with movements of equal
force. In contrast when she enters a ward where the patients are almost
totally lacking in the initiative necessary to move about or talk, she must
be able to speak and move as quietly as the occupants of this ward. From
these widely separated extremes the muscular action of the patients is car-
ried by means of infinite varieties of group rhythms, to a mean degree of
activity, and a quiet ward is left with movement that is pleasant but not
too rapid, while an over-active group will have been led to a few minutes
of quiet.
In doing this, sensitivity to action initiated by members of the class
is an essential and in this way the form of the sessions does not grow into
a rigid pattern, but can support and aid the patients in the group.
Not only must the leader be in sympathetic union with the moods of
the patients, but the music used must also be in their own tempo and the
color of the tones be those with which they are compatible. Whether an
assistant plays a piano or gramophone recordings, this holds true. Again
as with the rhythmic action and the approach of the dance leader, the music
starts rapidly and loudly on an active ward, or softly and with no dis-
traction on a depressed ward, and from these points it moves toward music
that is strong rhythmically but not exciting. On the wards where catatonic
patients are in the majority, men who have shown no inclination to talk,
will sing as they walk in rhythm together to such songs as "I've been work-
ing on the railroad", and 'Tavern in the Town" and afterwards gather
around the piano and to sway together and sing songs of Stephen Foster.
On the post-shock ward, men who are just coming out of the coma will sit up
in bed with a smile as the songs of our folk culture are played and sung.
Movement about the room, physical action in harmony with a group, and
relaxation of tension are the aims of rhythm in movement as used at Saint
Elizabeth's Hospital, rather than technical achievement as at a dance school.
245
MOTION PICTURE METHODS
THERAPEUTIC FILMS AND GROUP PSYCHOTHERAPY*
HOWARD P. ROME, LIEUT, COMDR. (MC), USNR
The group psychotherapy program (1, 2, 3), which has been developed
by the Medical Department, U. S. Navy, during this war, has had as one
of its projects the problem of brief, large-scale communication of psychi-
atric ideas and attitudes and principles. Aside from the very obvious non-
medical applications of these techniques (which are essentially those of
education and training), it is believed that these techniques, fully developed,
authenticated and amplified, are the crux of the pressing problems which
confront post-war psychiatry (4, S).
The benefits of psychiatric counsel and guidance both prophylactic and
therapeutic have been restricted to relatively few persons. Not only has
the lack of trained therapists imposed a very real limitation on the dissemi-
nation of psychiatric knowledge, but more important the semantic difficul-
ties created by the often painful, verbal formulation of psychodynamics
have added their imponderable bulk to the mass of existing emotional re-
sistance to the acceptance of psychiatric doctrine. It is generally agreed that
the techniques which have been developed to overcome these barriers on
the whole are inadequate, particularly so when they are applied to the
enormous therapeutic task presented by tens of thousands of patients.
Granted that brief treatment techniques which utilize the group approach
are the best tactics for a large-scale attack, it appears reasonable to sup-
pose that the use of audio-visual aids can set the stage by quickly creating
a receptive emotional tone. In turn this psychological "set" is condudve to
the elaboration of a wide range of appropriate patterns of adaptive and
projective behavior in the patient-audience. This was the hypothesis which
prompted the Bureau of Medicine and Surgery in 1943 to undertake the
production of a series of motion pictures for use in the psychiatric treat-
ment program. Thus far eight films (6) have been produced and distributed
*The opinions expressed herein are the personal ones of the author and are not
to be construed as necessarily indicative of the official opinion or policy of the Navy
Department.
247
485
486 GROUP PSYCHOTHERAPY
with the technical cooperation of the Training Films and Motion Picture
Branch of the Bureau of Aeronautics. Several immediate uses were intended
for these films. Primarily, they were made to serve as a supplement to
the established group psychotherapy program which operates in the general
and special Naval hospitals. In addition, they have been used as training
adjuncts in conjunction with other special psychiatric training films for
nurses, hospital corpsmen, and medical officers. Third, they have use as
training aids in a prophylactic and educational curriculum for the instruc-
tion of non-psychiatrists, both line and medical officers. Finally, for a
strictly limited experimental purpose, a few have been used as projective
diagnostic and screening tests in a manner 'similar to Murray's thematic
apperception and Rorschach's ink blot tests.
There is an old Chinese proverb: "Hundreds heard not like one see,"
which in essence states the raison d'etre- of training films. Their implica-
tions for psychiatric educational purposes are manifold. The imaginative
use of the camera can dynamically recreate the background, setting and
formulation of typical individual and group problems. In this way the
generic bases of motivation, attitude formation and behavior can be pre-
sented strikingly to many groups of persons. Moreover, this presentation
can be succinct and validated for standardized usefulness on a larger series
of patients than can any comparably controlled clinical psychiatric pro-
cedure. The drama and dynamics of intra and inter-personal relationships
lend themselves to cinematic portrayal with a realistic flexibility which has
very few limitations. Time, place and person can be treated graphically
to illustrate and simplify the complexity of psychodynamics. The use of
words, music and sound, and even color,* can provoke and guide trains
of associations to the end that individual patients and groups are emo-
tionally accessible. All that is then required for constructive action is the
catalytic ferment of a social setting which will translate private attitudes
and personal motivations into group participation and behavior. The clini-
cian is provided with a therapeutic instrument which can enrich his role.
The spade work having been done, he is free to deal with the nuances and
shades of individual difference which characterize the specific bases of his
patients' problems.
*Auroratone films have been used with psychotic patients for tin's purpose
(personal communication: 2nd Lieut. Elias Katz, A.G.D., Crile General Hospital).
248
MOTION PICTURE METHODS 487
The design and production of therapeutic films is tedious, time-consum-
ing and costly. They require the combined efforts of a team of specialists-
writers, artists, and production men, directors, photographers, sound men,
actors, and the host of technical assistants who are required for the making
of good motion pictures.
A therapeutic film (7) has to be conceived and produced in a manner
quite different from the usual recreational or entertainment film. This is
necessary to obtain the desired emotional response. The patient-audience
has to be conditioned, so to speak, to the point where the group discussion
which follows will be psychiatrically profitable. Further, the film must have
an intrinsic teaching value; its facts have to be presented in such a manner
that with the audience's personal experience as a background, the psycho-
therapy which precedes and follows, makes them acceptable as self-evident
truths (6).
It is essential at the outset to recognize that at best, the therapeutic
film is only an adjunct and a supplement to psychotherapy. The therapeutic
film has to have the capacity to provoke an emotional reliving of personal
experience. In order to accomplish this successfully, the theme has to have
generic validity and a capacity to stimulate the audience to specify in per-
sonal terms their response. The sequence of events has to be presented
synoptically. Literal chronology and factual detailing should be avoided; by
innuendo and implications the confusing, the irrelevant, and the inessential
can be subsumed in a backdrop of action. Camera, editing and cutting
techniques can be utilized to highlight important events. The use of wipes,
dissolves, insets, flashbacks and recapitulation can link the chain of cause
and effect relationships. The sound track is capable of being used with the
same kind of elasticity. Of equal importance is the timing of the film
showing. A good therapeutic film asks questions; therefore, ample allow-
ance in the therapeutic session which follows has to be made for the ex-
pression it evokes.
The most important cog in the production is the technical adviser.
The possibility of inadvertent errors in the preparation of such potent psy-
chological tools requires his constant dose association and cooperation. His
advice is necessary not only in the preparation of the script and the actual
filming of the picture, but also in the final stages of cutting and editing and
the recording of the sound track. There are many production details which
have to be planned carefully in compounding the balanced prescription of a
249
488 GROUP PSYCHOTHERAPY
psychiatric treatment film. Finally, not an inconsiderable item is the cost,
which for a standard black and white live-action film commercially made,
can average ten to twenty thousand dollars a reel. Full color pictures and
animation are more expensive. By and large, it is these factors which to
date have prohibited the wide-scale production and distribution of psychi-
atric films.
At the outset of the project under consideration, it was determined that
an important aspect of the use of films was concerned with the compilation
of various data on the indications and contra-indications for the use of
therapeutic films. It was decided that their use by the Bureau of Medicine
and Surgery would be restricted to selected patient groups; hence in much
the same way that various other activities in the daily program in Naval
-hospitals are medically prescribed, the use of the psychiatric films has been
subject to the same limitations.
Direct observation of the group, individual personal interview, and a
questionnaire poll have been used to gauge and control audience-reaction
so as to estimate the effect and potency of this therapeutic tool (7). Simi-
larly, experiments have been conducted to determine the usefulness of infra-
red audience photography as well as sound recordings of the group discus-
sions and comments which follow the film presentation. It was the purpose
to obtain both subjective and objective documentation of individual and
group response to motion pictures, and in that way to establish a scientific,
over-all frame of reference.
In keeping with this, the manner in which each film presents its problem
has been carefully controlled and purposely varied so that ultimately, if a
sufficient number of possible permutations of techniques are utilized, it will
be possible to determine the psychiatric limitations and applications of each.
In this regard, animation, live action, the use of a visible narrator and off-
screen narration, as well as the use of the story itself (intrinsic narration),
have been used in the script preparation. Thus, a number of fundamental
questions which arose concerning the theoretical and practical use of films
have been partly resolved by the use of the personal interview and the
opinion questionnaire. An illustration is available with regard to the film
entitled "Introduction to Combat Fatigue."
The technique of story presentation in this film employs the device of
a visible narrator a medical officer who presents, comments on, and
analyzes the subject. There is no film title, and the lead contains none of
250
MOTION PICTURE METHODS 489
the usual credit references. The film opens abruptly on the doctor in his
office in a Naval hospital. The familiar introductory musical score is miss-
ing, and the sound track throughout the film is recorded in such a manner
as to mute battle sounds. The doctor addresses the audience in an easy,
familiar way introducing the subject with a few descriptive remarks on
fear in combat. The basic theme of the film is fear its nature and manner
of appearance, its usefulness and inutility, as illustrated by the events in
the life of Corporal Ben Edwards, U, S. Marine Corps, a patient in that
hospital. By the use of a running commentary, which objectively analyzes
Edwards and his buddies' reactions to the anticipation and actual stress
of establishing and securing a beach head in jungle warfare, a sketch of the
natural history of combat fatigue in field troops is presented. Close-up shots
of a cat's reaction to the nearby presence of a dog are shown as an example
of a psychosomatic response to fear. This response is called in familiar
military language "Condition Red." The first few hundred feet of film are
used to establish the concept of the normality of psychological, physical,
and environmental stimuli leading to an appropriate total body response.
Gradually the pathological working of the fundamentally beneficial response
is unfolded by a series of dissolves. In all there are 113 scenes in the picture.
A summary of Edwards' present illness is presented by the following se-
quences:
1. Troop transport trip to the staging area; showing Edwards and
the other men each tense in his own way in anticipation of combat.
2. The landing operation which utilizes selected combat footage and
shows beach landing against light opposition, preliminary infiltration tac-
tics, the digging of fox holes, the precautions used against snipers and
air raids emphasis is placed on the provocative factors of continual alerts,
disturbed sleep, rain, cold food, etc., etc.
3. The climax' occurs during a forward maneuver in which Hal, Edwards'
buddy, is killed; Edwards' immediate reaction tt> this is shown.
4. There follows a series of shots of Edwards during the next few weeks
during which time he exhibits irritability, startle response, restlessness,
insomnia, culminating in his random firing at an imaginary Jap while on
night patrol, which ultimately lands him in a field hospital.
5. Edwards being admitted to the sick list, interview by the doctor who
points up the significant psychiatric symptomatology in the welter of
symptoms and behavior which Edwards presents, and establishes the
diagnosis of Combat Fatigue.
6. The narrator, Edwards' present doctor in a continental hospital,
251
490 GROUP PSYCHOTHERAPY
recapitulates and analyzes the symptoms Edwards now displays, pre-
sumably some weeks later.
7. The final series of scenes shows the hospital group therapy program
synoptically as it centers around Edwards.
This film has had a wide distribution throughout all branches of the
Service. A typical analysis of 200 consecutive patient questionnaires at
two separate treatment centers reveals the remarkable consistency of re-
sponse which patients under the care of different medical officers have
immediately after being shown the film.
1. 75% experience various psychosomatic reactions of which they
are aware; viz: nausea, palpitation, abdominal discomfort, sweating,
tremors, paresthesia, etc. These vary in intensity depending upon the
patient's preparation. Seemingly well patients without preparation some-
times show marked reactions.
2. 52% state they have startle reactions. These have also been docu-
mented by direct observation and infra:red audience photography. It
should be noted that this occurrence is despite the fact that the back-
ground battle sounds (explosions, rifle and gun fire) are muted to the
point of minimal audibility. Here again the degree of preparation is
an important determinant.
3. 86% state they are vividly reminded of their own battle experi-
ences. In this regard, it should be remembered that only 30% had ac-
tually participated themselves in a similar type of jungle warfare,
e.g., 70% of the entire group were naval personnel whose combat experi-
ence has been limited to sea duty.
4. 70% state that they identify themselves with the characters and
the events portrayed.
5. 76% say that they feel that the film helped them to understand
more clearly the nature of Combat Fatigue.
6. 45%, according to their own statements and documented obser-
vation, continued to be emotionally aroused for two days following the
first showing of the film. They state they sleep poorly, experience more
disturbing dreams, feel restless and irritable, sweat more, and are "jumpy."
This undercarriage of tension can be used readily to accomplish bene-
ficial abreaction and a constructive cathexis. Patients in this vulnerable
state are amenable to integrative psychotherapy.
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MOTION PICTURE METHODS 491
Despite the expectation of wide variability in response, there is on the
contrary a surprisingly high rate of similarity of behavior and reaction
which is significantly immediately apparent to the numbers of the group
themselves. A further analysis shows that almost universally in new patients
unprepared for the realistic portrayal of a commonly traumatic experience,
there is an almost critical exacerbation of symptomatology; however, in
sharp differentiation those patients who have been in therapy for even a
brief period are better able to integrate their experiences and therefore
profit by an opportunity to abreact and analyze their induced reactions,
either in personal terms or vicariously in terms of the film characters. Like
drugs or other potent therapy, therapeutic films have the capacity for incit-
ing response whose benefit is proportional to the skill and judgment of the
therapist.
As Mitchell (8) has pointed out, the use of audio-visual aids has many
objectives. They help the patient:
1. To consider many factors in accounting for his own and other
people's behavior.
2. To be more objective about this behavior.
3. To distinguish the real reasons prompting this behavior instead
of the superficial rationalizations which he uses to explain and justify his
attitudes and motives.
4. To be more tolerant of others' attitudes and acts which are con-
trary to his own.
5. To undertake constructive action in such a way that more op-
portunities are presented for better human relations.
The war has shown that survival in our culture depends upon the
ability of the individual to adjust himself to social change, drastic changes
in the constellation of inter-personal relationships. Man possesses the poten-
tiality for this adjustment; what is required is the development of kinetic
techniques which will enable him to evolve the requisite behavior patterns
easily and with less cost in terms of conflict and unhappiness. Therapeutic
films can condense the chronology of social and psychic events in such a
manner that a life-like emotional participation on a trial scale is possible.
Functional behavior patterns can be purposely developed and the task of
psychiatric education and rehabilitation can be greatly facilitated.
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492 GROUP PSYCHOTHERAPY
BIBLIOGRAPHY
L Rome, Howard P., "Military Group Psychotherapy," Manual of Mili-
tary Neuropsychiatry, Saunders, Phila. 1944.
2. Rome, Howard P., "The War and its Psychiatric Problems/' 7. Nerv.
and Ment. Dis., 101: 445-450, May, 1945.
3. Rome, Howard P., "Military Group Psychotherapy/ 7 Amer. Journal
Psych., 101: 494-497, Jan., 1945.
4. Rome, Howard P., "The Use of Films in Rehabilitation of NP Patients/'
delivered to the Washington Visual War Workers, March 28, 1945.
5. Keliher, A. V., "Human Relations, Education and American Democra-
cy/ 3 Progressive Education Association, N. Y., 1944.
6. Braceland, Francis T., "Group Psychotherapy," Sociometry, Vol. VIII,
No. 3/4, 1945.
7. Moreno, J. L., "Psychodrama and Therapeutic Motion Pictures,"
Sociomtry, Vol. VII, No. 2, 1944.
8. Rome, Howard P., "Audio-visual Aids in Psychiatry," Hospital Corps
Quarterly, 18: 37-38, Sept., 1945.
9. Rome, Howard P., "Group Psychotherapy," Dis. New. System, 6: 237-
241, Aug., 1945.
10. Mitchell, James P., "The Discussion of Human Relations Through
Films," Progressive Education Association, N. Y. 7 1944.
254
AUDIENCE REACTIONS TO THERAPEUTIC FILMS
ZERKA TOEMAN
Psyckodramatic Institute, New York City
INTRODUCTION
In his new book on psychodrama, the chapter dealing with therapeutic
films,* Moreno says: "In the last few years a number of motion pictures
have been produced, as Lady in the Dark, Now Voyager, Conflict, Love
Letters, Spellbound, which represent a dabbling of the motion picture in-
dustry with therapeutic (often with straight psychiatric) projects. Due to
the fact that the instigators, producers and actors have no psychiatric and
psychological training, these films can well be classified as 'pseudo' thera-
peutic. Because of the mass influence which motion pictures exercise they
can be called dangerous undertakings, spreading false notions, portraying un-
true explanations of causes and distorted cures upon the screen. Upon closer
analysis of these films as to their content, the influence of psychoanalytic
theory is one of the outstanding features. The import of childhood trauma,
of dreams and repressions are some of the most popular hypotheses used for
the explanation of psychic conflicts. However, there is in these motion pic-
ture productions & feature much more involved which is not so obvious, the
psychodrama. The psychoanalytic situation is a patient-physician relation,
it is a form of verbal interview; the real stuff of life, the situations and con-
flicts, when and as they occur, are kept out of it. But the producers of these
films do not try to duplicate psychoanalytic interview as it occurs in fact,
which would be rather boring to the public; they try to produce a 'drama/
to show that by enacting and re-enacting of scenes a mental catharsis can
be produced. Unconsciously therefore, they have been entering into the
domain of the therapeutic drama or, as it is usually called, the psychodrama.
When preparing the script, selecting the actors, editing and cutting the
film, weighing the effects of the film upon audiences, factors and ideas are
introduced by them borrowed from psychodrama, which they make up with-
out sufficient knowledge of its principles of producing therapeutic films and
of problems involved in audience catharsis. Unconsciously they are using,
*Therapeutic film, a term coined and defined by Moreno, as "a type of motion
picture whose main object is the treatment of audiences." See Psychodrama Monograph,
No. 11, p. 13.
255
493
494 GROUP PSYCHOTHERAPY
during the production, the warming up of actors (always with the idea in
view whether the audiences will be similarly warmed up), auxiliary ego
methods, the process of role-playing and role-identification, which have
become valuable concepts in the analysis and guidance of audiences.
"Such rapid popularization of an idea would be flattering, were it not
for the increasing number of seemingly psychiatric motion pictures turned
loose upon the public by unskilled men, producing undesirable effects. An
important medium by which masses of people can be treated simultaneously
has come into the hands of laymen who are unwittingly promoting a form
of quackery which may become the greatest barrier to the psychodramatic
film of the future."*
Moreno's pioneer films "Spontaneity Training" produced in Hudson,
N. Y., in the autumn of 1934, were shown to two types of audiences, one
consisting largely of college students, adolescents, mostly female, compara-
ble in age, though not in social and academic background to the subject in
the film, Audience I. The second type of audience consisted mainly of teach-
ers and professional workers, a mature adult audience, Audience II. The
difference in reaction to the films was striking and will be discussed later.
Sitting in as participant observer the author attempted to collect and analyze
these reactions.
DESCRIPTION OF THE FILMS
The motion pictures are entirely extemporaneous and though they had
been made more than eleven years ago, it is pertinent to state that no one
experienced them as dated, and that their age did not in any way detract
from their impact upon the audience. In order to understand the motives
given for the audience reactions, we are describing here the salient points
of the films shown. The first film is an introduction to the warming up to
and subsequent transfer of simple spontaneity states, as for instance, a
sculptress starting a new creation in clay, a mother visiting her daughter at
a boarding school, a girl waiting for someone who does not come, a business
executive calling for greater efforts from her staff, a hospital supervisor giv-
ing instructions to nurses in an emergency. Criticism and interpretation from
the director followed each performance, no scene was repeated. The second
film is a therapeutic film. A young girl from a well to do home, but of emo-
tional instability, after having failed in the past in regard to various social
*Psychodrama, Collected Papers, Volume I, Beacon House, New York, 1945.
256
MOTION PICTURE METHODS 495
demands, learns how to become a waitress. We see her first without train-
ing, in the role of a waitress in a restaurant. From the start the subject
reveals, besides her deficiencies as a waitress, many personality difficul-
ties which are analyzed and treated, not apart from the vocational task,
but in conjunction with it. The film shows her development in the role of a
waitress, before, during and after the treatment. Fellow students in the
film watched her in her first attempt when she got into a heated argument
with one of her customers, taking sides for and against. These co-students,
chosen because of similar difficulties and interests to sit in on this subject's
training, were learning via mirror technique. Some of the most important
features of the films are that they copy in procedure psychodramatic sessions
in the flesh; the director interviews the subject, assigns a role for her.
The subject warms up to her role by physical starters as, arranging the water
glasses, setting the table, etc., aided by an auxiliary ego who takes the part of
the restaurant hostess. Two other auxiliary egos appear as guests who sit at
the trainee's table. Resistances were interpolated by the director, who had in-
structed one of the auxiliary ego guests to make a complaint in reference to
the subject's service. The guest stated that the waitress brought her coffee
although she asked for tea. This mild reprimand caused an immediate argu-
ment on the part of the subject. Verbatim reports and records of all actions,
gestures and carriage were made by a fellow student. Upon completion of
the scene every co-student in the film made her comments, criticising the
subject's behavior. The director analyzed the total performance, noting
weaknesses to be especially dealt with in further training. The complete
records were copied and handed to each of the students who took them home
to study. The next scene shows the subject at home, reading over her report
and realizing her error, demonstrating with a friend how she should have
acted. The last part of the film shows the same girl after several months
of spontaneity training again in a restaurant waiting on customers. She
showed poise, composure and ability to handle the implements and her clients
with facility. Training consisted first of a period of learning to handle the
dishes and silverware without customers; later customers entered into the
situation, girls well liked by the subject who offered no interpersonal con-
flict or criticism to the trainee. During a later phase of training more diffi-
cult assignments were given as for example, students to whom the subject
was indifferent, and lastly, girls who were rejected in the actual life setting
by the subject were placed opposite her. In this final phase conflict situa-
257
496 GROUP PSYCHOTHERAPY
turns were produced which the trainee learned to master. Again records of
every session were made and criticism of the co-students within the film
carefully noted and an analysis made by the director.
REACTIONS, AUDIENCE I
Our audience participation ranged from full and partial role-identifica-
tion to total rejection of the subject. This adolescent type of audience pro-
duced responses which were tinged with a good deal of emotion, as for
instance in complete role identification: "That was me. I could just see
myself. I always seem to get into trouble with people. I am a salesgirl in
a department store but that is the kind of training I need, it would make
a world of difference to me." "I never saw anything so simple and yet
fantastic in my life, and she learned so quickly." "I thought it was so
real. I too, would have quarrelled with the customer." "She did a won-
derful job. Imagine standing up in front of your classmates and taking all
that criticism from them. She's got courage." The partial enthusiasts re-
ported: "I might have thought those things, but I would never say them,
The customer is always right." "She learned well, but she should not
have argued with her guest." "I could never be a waitress, even with
training." "I don't think I could have done that well." Rejections were
few in this type of audience, but several critical remarks were made: "She
was silly, she looked as if the guest had committed a crime." "All that
fuss over a cup of tea." "If I'd been the guest I would have walked
out." "It was a good thing she was trained^ she'd never have been able
to hold a waitress 7 job otherwise."
REACTIONS, AUDIENCE II
This type of audience, that of adults and professional workers showed
little role identification with the subject and verbally produced largely
intellectual reactions: "To what extent did the training in this specific
situation enable the subject to deal adequately with other life situations,
and was training limited to this type of situation only?" "It was amaz-
ing to see her progress, but I would have liked the film to show more of
the steps in her training." "Why was treatment and training not di-
rected at her immediate life conflicts?" "We can appredate that the
fact that co-students were watching her and offering comments would be
quite a factor in her ability to take it. I don't believe she would have
258
MOTION PICTURE METHODS 497
accepted criticism so well from adults." "Were the girls sitting in on
training only taught by indirect, spectator methods, or did they also get
a chance to appear as subjects?"
DISCUSSION OF AUDIENCE PARTICIPATION
The participation quotient of Audience type I was considerably
greater than that of type II, ranging from 73% to 89%, in audiences of
similar construction to whom these films were shown, in the first type,
from 31% to 42% in the second. The amount of catharsis received and
observable in the first type was thus significantly greater than in the
second. The latter showed irritation, rejection, conflicts and endless
questioning. It would seem that the amount of catharsis obtained from
therapeutic motion films by the audience depends upon: a) the problem
portrayed; b) the type of actor; c) the solution to the problem; d) the
type of audience and, e) the interaction between the members of the
audience. Each of these factors contribute to the amount of participation
and role identification possible on the part of the spectators.
CONCLUSION
This sort of inquiry leads us to believe that the limitation of the
therapeutic film is that, especially as it is able to stir up audiences, many
spectators may leave the theatre with a number of conflicts sensitized and
dormant problems reawakened without being able to satisfy and resolve
what it has activated. The follow-up, indeed, the completion by an actual
psychodramatic session under skilled guidance appears to be the only
alternative to an otherwise risky therapeutic undertaking.
259
HISTORICAL SURVEY
ORIGINS AND DEVELOPMENT OF GROUP PSYCHOTHERAPY
A Historical Survey, 1930-1945
JOSEPH I. MEIERS, M.D.
Of the growth of Group Psychotherapy we may readily say the same
as of the evolution of Psychotherapy proper these words which the well
known psychologist Ebbinghaus used once when speaking of the development
of his field, Psychology: "It has a long Past but a short History." This
apparent contradiction is, indeed, but a nice way to illustrate the enormous
number of almost untraceable roots which both Psychotherapy and Group
Psychotherapy have in far antiquity. The history of cults and religion, of
folklore, folk tales and poetry, of Egyptian, Greek, Oriental, East Indian,
Chinese, Polynesian and last but not least our own American Indian medi-
cine provides ample fields of the "Past" where these roots can be found.
On the other hand, by "History" of both Psychotherapy and Group Psycho-
therapy we mean nothing but the course of either of these healing arts in
the form of well recorded and "systematized" disciplines; specialties with-
in the ever growing realm of our Civilization, aging into rigidity and striving
for rejuvenation. It would be of interest to demonstrate how this contrast
of "long past" and "short history" becomes even more paradoxical in a
comparison of the coming age of both: the concept of Psychotherapy and
that of Group Psychotherapy. However, we will leave its proof for another
occasion. (Fig. 1)
In this connection it might be of interest to quote the almost prophetic
words of Johannes Christian Reil (1759-1813) who in his "Rhapsodies on
the Application of Psychic Methods in the Treatment of Mental Disturb-
ances," said in 1803 that ". . . the medical Faculties will soon be obliged
to add to the two existing medical degrees (of medicine and of surgery JM)
still a third, namely, the doctorate in Psychotherapy", he thus becoming
the coiner of this new term. (Let us ask ourselves, just in passing: has
ReiTs claim been quite realized within these ISO years?)
The term Group Psychotherapy, the name for the "younger" branch
of the "psychic method" of the Art of Healing, seems to emerge in recorded
form first in 1931. Witness the words of the late William Alanson White.
261
499
500
GROUP PSYCHOTHERAPY
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262
HISTORICAL SURVEY SOI
White, in his introductory remarks as chairman to the Special Conference
during the meeting of the American Psychiatric Association held in Phila-
delphia in 1932 and referring to the meeting held at Toronto in May 193 1,
recorded Jacob L. Moreno as having "suggested group psychotherapy," in
the Report of the Conference on "The Application of the Group Method to
the Classification of Prisoners". 1
Many things have happened since the now historical Philadelphia
meeting to show that it was deeply meaningful that William A. White, then
superintendent of St. Elizabeths Hospital, Washington, D. C., watched
over the initial phase of the development of Group Psychotherapy in the
U. S. A. as an officially recognized method. Since the Conference on Group
Method took place in 1932, whence emanated the earliest organized influ-
ence of Group Psychotherapy upon the psychiatrists of North America,
White himself sponsored the introduction of sociometrically grounded group
study into St. Elizabeths Hospital. It was the late Dr. Winifred Richmond,
Chief Psychologist at St. Elizabeths at that time, who reported Moreno's
group procedure applied to a group of nurses at the hospital in 1936,
Doctor White again, later on, took interest in the first establishment of the
psychodramatic method of group psychotherapy in the United States.
And in 1940, it was Dr. Winfred Overholser (W. A. White's successor
as superintendent of St. Elizabeths) who, assisted by Margaret Hagan,
Field Director of American Red Cross, made possible the founding of the
first Theatre for the Psychodrama in the largest federal mental hospital in
this country.
Thus it was completely in keeping with the focal role of St. Elizabeths
Hospital has played in the development of group psychotherapy and psycho-
drama in America, that Dr. Roscoe W. Hall, its clinical director, was asked
to act as the chairman of the latest Conference on Group Psychotherapy
at the Centennial Meeting of the A.P.A. in Philadelphia, May 1944.
Today, as group psychotherapy has penetrated as a fact and is even
more establishing itself as an "idea" in the minds of ever widening ranks
of physicians, psychiatrists, pedagogues, penologists, occupational therapists,
Published by the National Committee on Prisons and Prison Labor, New York,
1932, republished elsewhere in this symposium on page 15. See also J. L. Moreno,
"Group Method and Group Psychotherapy," published in 1931, chapters on Group
Therapy, pp. 60-61, Illustration of Group Therapeutics, pp. 92-94, and The Application
to the Institution for the Insane, pp. 95-97, See also Who Shall Survive?, 1934, pp.
301 and 429 on Group Therapy and Group Psychotherapy.
263
502 GROUP PSYCHOTHERAPY
and so on doesn't it sound almost incredible that this very term was
introduced Into our vocabulary less than IS years ago? Yet, this writer
at least has not been able to trace it, so far, in the literature prior to that
date. We want to show in the following investigation how, during its rela-
tively brief history, the concept of group psychotherapy has comprised a
gamut of many different and in some ways even contradictory methods
and approaches. 2
THE MOTHER SOIL OF EARLIEST GROUP PSYCHOTHERAPY
Before, however, turning to a survey of these manifold schools of mod-
ern group psychotherapy it appears justified to ask ourselves: What made
for the "kairos", the propitious moment of its birth? Why did it arise
just at the time it did?
This much can be said: After approximately SO years of the existence
of the various psychotherapeutic methods (mainly in France and Switzer-
land) and after the rise of the psychoanalytic methods all of these cen-
tered upon the individual aloneit seemed inevitable that someone had
to feel that the advantages of individual psychotherapy should be extended
to the greatest possible number of sufferers. Here, too, necessity became
the mother of invention. However, as so often in history, it was not the
adherents of existing schools of individual psychotherapy (hidebound as
most of them were in their specific methods) who felt the urge and there-
fore "hit upon" the close-lying vein of group therapy. 3 Here, again "out-
siders" struck the ore.
THE PRECURSORS
It is true, some approach to group psychotherapy was made even by
one or another of the individual-centered schools.
*However varied they are, they have at least one common denominator. Group
psychotherapy treats individuals in groups and can be contrasted with the concept
of individual psychotherapy in which a person is treated as an individual only. This
contrast is by no means effaced by the fact that many (if not most) group psycho-
therapeutic methods allow or employ either in principle or in certain phasesthe use
of the "individualistic" treatment of their group members, too.
*In this connection, it might be of interest to mention what George H. Alexander
wrote, as late as 1940, in his "Psychotherapy and the Psychotherapist New Orientation,"
an otherwise highly interesting paper: ". . . There is a lamentable lack of adequately
trained psychotherapists now available to handle the large number of patients who
seek treatment . . . ," etc. (In Psychosomatk Medkine, vol, 2, July 1940.) Group
Therapy is never as much as alluded to, in that extensive article.
264
HISTORICAL SURVEY 503
For instance, it was a practice in the consultation polyclinic of Alfred
Adler and his Individual Psychology students of Vienna, that in con-
sultation with neurotics (mainly children) after an initial "individual"
exploration, other persons, parents, students and even non-belonging
parties might be present at the discussion of the case with the juvenile.
V N^
However-, this was more in the way of a by-product, never developed into
"straight" group therapy.
It may ^eem a sheer coincidence that the earliest and most typical
founders of true group psychotherapy were two men who started from
entirely different angles. One, a medical doctor in the highly industrialized
America of the first decade of this century, was J. H. Pratt of Boston, He,
as early as 1906, introduced "mass instruction" into the treatment of tuber-
culous patients. This he gradually extended into classes of instruction and
encouragement, by many psychological devices, of psychoneurotics and
what now might be called sufferers of "psychosomatic" cases. It was in
April 1930 that the first class of what was subsequently called "Thought
Control" convened. Typical for the importance and specific weight .of the
group members in Pratt's movement is the fact that the name "Thought
Control" was given not by him, but suggested by one of his first class
members. His example was followed not only by his personal students and
co-workers but has found following and extensive application in various
fields, for instance work with children having reading difficulties; in some
state hospitals, etc., far beyond its original locale of application the out-
patient clinic for psychoneurotics.
The other early creation of a methodology that later was to become
the fully developed sociometrically and psychodramatically based group
psychotherapy, originated in Vienna, a big city which, like Boston, was a
centre of industry and a metropolis of learning. Moreno started to practice
group psychotherapy by using three different approaches.
rfThe first approach led to psychodrama. He started around 1909 in the
firm of staging written plays with children and juveniles, but soon passed
over to the completely original practice of "letting them play spontaneously"
their own problems on self-creative primitive stages in the since famous
Vienna Meadow Gardens (Augaerten). In 1911, Moreno created "together"
(as he himself insists) with hundreds of children and adolescents a "chil-
dren's theatre for spontaneity" where the first recorded psychodramatic
sessions were produced. In one of them, "The Godhead as Comedian"
Moreno let it be known: "... The theatre up to now has mirrored before
265
504 GROUP PSYCHOTHERAPY
our eyes the pains of alien things; tonight, however, it has played to us
our own woe. . . ." OutjOf this developed in the early twenties the "Stegreif
Theater" for adults in Vienna and the Living Newspaper.
The second and third approach led to .sodometry. He began, around
1911, by formulating a plan of how the problem of prostitution could be
helped. This led to the forming of self-help groups, initiated and run by
the girls themselves. The change from a symbolic to a personal status as
members of the community, instead of as outcasts, had a* cathartic effect,
The method of not trying "to reform 7 '* them but to arouse the dynamic
factors operating within their own groups as a lever towards the realization
of their aims, proved highly beneficial. A third approach was made in 1916
in Mitterndorf near Vienna & place of enforced "relocation" of South
Tyrolian (Italian) peasants when he proposed to the Austrian adminis-
tration a form of "group therapy" (meant to adapt these war victims in
the best possible way to their new residence) that was based on the prin-
ciples of sociometrk group analysis. /
H brought these ideas to the United States in 1927, started a "thera-
peutic (Impromptu) theatre" and 'further developed the application of
sociometric analysis to psychotherapeutic influence upon various "groupings"
in situ: at Sing Sing Prison (New York) and at the N. Y. State Training
School for Girls. All this matured towards the "Group Plan" which became
the topic of the above mentioned conference in 1932.
Thus originated what we know in the U. S. A. today as the psycho-
dramatic and ^sociometric methods, with their ever expanding applications
in psychiatry, schools, training of nurses, penological work and so on.
It deserves to be mentioned that within that early period, S. E. Jellifie
wrote his important article (too little known to most) :' "Psychotherapy and
the Drama" (1917). In it we find these significant statements: ". . '. the
drama is the work of Art which has most adapted itself to (this kind of)
therapy. . . ."
THE PIONEER PERIOD
It was in the second part of the twenties that Trigant Burrow wrote
most of his papers about the "group method of analysis", the earliest being
"Social Images Versus Reality" (1924).
Prom 1935 on, especially in America, the activities and various begin-
nings of group psychotherapy become too numerous to be pointed out here
by the single names of authors: founders or followers. The springs have
become rivulets, and these have merged into streams. It was the late Giles
266
HISTORICAL SURVEY SOS
W. Thomas who, in 1943, wrote the, first comprehensive survey "Group
Psychotherapy, A Review of the .Recent Literature". In this paper he at-
tempted, following Freudian principles, a categorization of group psycho-
therapy but only in one plane: by opposing -the mutually-polaric principles
of "analytic" on one side, with the "repressive-inspirational" approach on
the other. This categorization comprises only the differentiation as to the
ideational "content" with which the group of patients is approached by the
therapist (leader), analytic versus repressive-inspirational method, both of
which "poles" fall, in practice, mainly into the didactic (lectural-discus-
sional) sphere (see Figure 1, No. III). Thomas' paper is regarded by this
writer as an aid in understanding the history and some principles of group
psychotherapy. In its goal, at least, it reaches beyond being a mere "review
of the literature."
But Thomas showed in his informative paper at least one serious short-
coming. Although he mentions the various psychological entities, for in-
stance: assurance, insight, identification with therapist-leader, etc. (as
brought forth in the reports of the many research workers and "practition-
ers" of group psychotherapy) and made the "application" of those entities
more or less responsible for their successes, he did not go far enough in seek-
ing out the other principles: Structure of the Groups, Forms of Activities,
Role of the "one" (leader-therapist) vs. the "many" (the whole of the group
or audience); the essential difference between Lecture-Explanation vs.
group-member Interaction in free discussion and dramatic, spontaneous
Self-presentationall of these principles (and some more) underlying the
action and effects of group psychotherapy. It is, thus, not a matter of
chance that Thomas, although he mentions the psychodramatic procedures
at some length (pp. 173-4), fails to notice that in his "analytic vs. repres-
sive" polar scheme there is simply no room to place the dramatic-
intenactionally accented types of group psychotherapy because these types
transcend beyond that "polarity", encompassing both its poles. Further,
Thomas failed to notice the basic importance of the sociometric foundation
underlying the activity of the various types of group psychotherapy: the
preceding exploration of the social atom, etc.
Moreno has been generally recognized as the chief exponent of psycho-
drama and sociometry. But what has been known to a small group has
never been made fully clear to the profession at large: he has been also
chief mover in the development of a scientifically based group psychotherapy.
Moreno was the first to see the need (1) for knowing the Dynamic Struc-
267
506 GROUP PSYCHOTHERAPY
ture of Groups as prerequisite to the therapy of groups, and (2) for system-
atizing such knowledge. The impressive development of sociometry in the
last twenty years presents itself at the same time as the inventing and
sharpening of instruments for valid diagnosis of dynamic group structure.
Various methods of the self-direction of groups and therapeutic re-grouping
arose on the basis of adequate group diagnosis. Moreno established the
view that no form of group therapy, whether didactic (lecture, discussion),
psychoanalytic (interview of patients in front of the group, and interpret-
ing their complaints by means of psychoanalytic concepts), esthetic (mo-
tion pictures and other visual aids) ought to be undertaken and can be
called scientific unless the "object" (a group in situ or a specific group
before the therapist) has been diagnostically explored as to its psycho-socio-
cultural organization.
BASIC CATEGORIES IN GROUP PSYCHOTHERAPY
We now propose to introduce the following main pairs of polaric
categories:
I. The didactic approach vs. the dramic: 6 The didactic method being
represented best, that is, most typically (though by no means solely) by
Pratt's "Thought Control classes; the dramic, by Psychodrama of Moreno.
II. To view the whole of Group Psychotherapeutic approaches under
a more structural angle:
Type 1 (the kyriotropic). 7 Here the leader, or therapeutic instructor,
has in the given set-up the overwhelming (or at least, overweighing) role,
thus influencing as it were "from above" each patient-member separately:
aside from the undeniable additional creation of a "mass fluid" atmosphere
without which any successful group work is impossible.
To this Type 1, belong all of the more didactic or indoctrinating groups,
like "Thought Control" and similar lecturing methods; also, most of the
"group-analyses" schools.
Type 2 (the koinotropic). 8 The inter-action of the members, in fact
*Drdmic is introduced specifically because the word "dramatic" has already too
many well-defined meanings and associations. The other word derived from the Greek
drdo = "do, act" would be "drastic", which in its turn is also too much loaded with
conserved associations.
'"Kyrio-tropic", from kyrios, Greek = "the master". Thus, "kyriotropic" =
"turned towards the master."
*K<rinl, Greek = "community"; thus, "koinotropic" = "turned", or "leaning
towards the community."
From these words easily can be derived the nouns: kyriotropism vs. koinotropism.
268
HISTORICAL SURVEY 507
the "living-himself-out" (on a spontaneity stage, or in other actions) of each
patient and the sum total of these actions and their inter-action is what is
prevalent in this type of method; whereas the "director" stands by, at
times entirely non-interfering, in the background. This Type 2 in its
greatest purity is represented, to my knowledge, by psychodrama (and
sociodrama) of J. L. Moreno.
PEG, 2
TABLE OF CATEGORIES op GROUP PSYCEOTHERAPIES*
L As to the Constitution of the Group:
Amorphic vs. structured ("crystalized") group
II. As to Sources and Transfer of Influence:
Leader-centered vs. group-centered method
(Kyriotropic vs, (Koinotropic)
III. As to Mode of Influence:
"Lectural vs. "Dramatic" (inter-actional) method
or (didactic" vs. "dramic")
IV. As to Form of Procedure:
Spontaneous vs. "Aforethought" Form
(Freedom of experience and ex- (Suppressed experience and ex-
pression; therapist, or speaker pression; therapist memorizes
[from inside the group] is ex- lecture or rehearses production;
temporaneous; the audience un- the audience is prepared and
restrained) governed by fixed rules)
V. As to Locus of Treatment:
Situational vs. Derivative method
(Treatment in "loco nascendi", t (Treatment in an artificial or
in situ) 5 constructed situation)
(For instance: in family, in (In clinics, etc.)
camp, etc.)
VI. As to Goal of Treatment:
Causal vs. Symptomatic
Of course, between these typical "poles" of group categories, there are
such in-between features as, for instance, the "Club" system described by
J. Bierer (1943) in England. It seems to develop on its three different
*This Table of Categories is partly based on Moreno's scheme of classification, see
p, 318 in this issue.
""In other words, psychological treatment is projected away from the clinic into
real life situations, and techniques for a proper procedure to be used on the spot,
developed." J. L. Moreno, "Group Method and Group Psychotherapy," Beacon House,
Sociometry Monograph, No. 5, page 94, New York, 1931.
269
508 GROUP PSYCHOTHERAPY
"levels" (in-patients and out-patients of a mental hospital, for both sexes),
a pretty strong self-activity of the patients' group, with the psychothera-
peutic leader keeping more or less in the background.
As another of such "intermediate" approaches one may mention the
psychotherapeutic "venture" devised by this writer (Meiers) in 1943-44
in Philadelphia and successfully repeated later: the method of "Informal
Talks by a Patient, on a topic 'best known' to him, before a group of co-
patients, with discussion."
One patient is induced to volunteer a talk; the topic is left to him
but taken preferably from the field of his closest interest (work, hobby,
etc.). However, the approximate theme Is agreed upon if time allows
by the group beforehand (one or two days in advance) so as to avoid
a topic that might be hard to understand or boring to the majority.
This method seems to have at least three advantages: (1) it strength-
ens the self-confidence of the "orator or patient" in his abilities in
many respects (concentration, self-expression, etc.), thus is an excel-
lent means for a "finishing touch" before discharge; (2) gives both
pleasure and confidence to all other group members that one of them
is so able and so will they be, and that every topic which each of
them will choose in turn, will be equally interesting and acceptable;
(3) it can be applied either with little preparation or on the spur of
the moment (spontaneously) and is often even better the latter way.
The therapist is left completely "out of the circle" (although he may
attend "as a guest") ; sometimes he may be needed or of help to start
the patients' discussion on the "talk", or to keep it going, with gentle,
humorous prodding. This, however, is needed generally only in the
beginnings of the "Club"; subsequently he may discuss the talk and
Its discussion with individual patients or with the group.
TENDENCIES WITHIN THE VARIOUS SCHOOLS OF GROUP PSYCHOTHERAPY
A few more words may be allowed about what is felt by this writer to
be a certain tendency, or even may be called a "shift", inside the whole
of modern group psychotherapy, both in this country and apparently also
in Great Britain. (Information of progress, if any, in the rest of Europe
unfortunately has been unavailable to me so far.) It appears that the
"inter-actional" and "dramic" type of group psychotherapy (the koino-
tropic method that tries to accentuate the self-activity of the group as a
whole and of its members and keep the "director" in the background)
comes to the fore and gains momentum. There is no denying that this
impression might be, at least partly, a result of "wishful thinking", as in
this matter there is hardly any statistical yardstick available as yet. How-
270
HISTORICAL SURVEY 509
ever, this impression has been strengthened especially during this war when
many recent writers clearly seemed to stressconsciously or even uncon-
sciouslythis point in the presentation of their work, even those outside
the psychodramatic-sociometric orbit proper. Some examples will be given
in the next section.
FIG. 3
Leader-centered Group-centered
A\- male X >= attraction
QJ female X > = repulsion
L = leader (inside group) L = leader (outside group)
THE DEVELOPMENT DURING THE WAR (1939-1941-1945)
Already before the outbreak of World War II in 1939 and its engulfing
the United States in '41, there had been an ever growing expansion of the
various group-psychotherapeutic units, older and newly budding. This ex-
pressed itself in their numerous publications which markedly increased the
bibliography especially since 1942-43. (It should be remembered that
earlier endeavors are reflected often in rather late reports.)
However, It was the war with its accelerating "demands" for group
psychotherapy (both extensively and intensively) that became a real chal-
lenge to all the various schools and units. Most of them came forward
with new projects and plans to meet the emergency, preferably in the
military field, submitted them often for approval to various government
agencies and, of course, especially to the responsible neuropsychiatric leaders
of the Armed Forces. Some civilian needs (children, mothers, youth) were
not overlooked though. All this reflects itself in our literature listing. It
is too early, however, to even attempt to evaluate with the sharp tool of
statistical analysis the problem of how successful group psychotherapy as
a whole has been in meeting the needs during the war from 1939-45:
271
510 GROUP PSYCHOTHERAPY
First, in an over-all sense in the percentage of success (recovery
or improvement of neuroses and psychoses; in the "prevention" of child
and youth delinquency, etc.)*
Second, in a comparison of its different methods and schools, with
each other, in all these fields.
Third, in a comparison -with individual psychotherapeut'ic methods
(where such comparison should be feasible), for instance with the
"brief therapy" methods put forward by some leaders in psychoanalysis;
also compared with individual narcosynthesis and other similar methods.
Fourth, questioning ourselves candidly how much group psycho-
therapists themselves (and the general public) expected from this spe-
cialty and what shortcomings have shown up and what were their
causes. The last inquiry seems especially important for the role group
psychotherapy ought to play in the hard (and probably not to rest-
ful) postwar period.
Even though it seems that we have not yet sufficient bases for such
vast and necessary comparative-statistical investigations, a few single ques-
tions and problems may be touched upon.
There is what E. A. Strecker has called in his introduction to "Psychi-
atry in Modern Warfare" the missed "responsibility of psychiatry" be-
tween the two wars, its lag in learning the lesson of World War I to prepare
itself for the onslaught of the following world cataclysm. Confronted with
this self-criticism of the older and more official discipline of academic psy-
chiatry can the young and, so to speak, youthful community of group
psychotherapy afford to subject itself to less serious searching of the soul?
Did group psychotherapy do enough in the war? Was it allowed to do
more? Whence did serious faults, bureaucratisms, etc., arise?
In contrast to such stern and, maybe, uneasy questions of self-clarifica-
tion, there are doubtless some brighter points to be considered, some of
them, it seems, of extreme theoretical and practical interest.
There is, first of all, what may be called the official recognition of
group psychotherapy and psychodrama by the War Department.
War Department Technical Bulletin 103 stated that group therapy
has advantages over individual therapy in dealing with suspicious, hos-
tile and guilty feelings and minimizes personal feelings.
It is suggested that groups be homogenous, patients be seen indi-
vidually first and then in groups . . . from 7 to 25 individuals meeting
three to six times weekly for about one hour.
War Department Bulletin, TB MED 84 recommended in the section on
Treatment Methods:
(f) Dramatics. To be used in impromptu form (psychodrama of
Moreno) as group psychotherapy. If talent is available, the use of
short skits, musical numbers, and pantomime,
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HISTORICAL SURVEY 511
But besides this, so to speak, accolade given to the abstract concept
of group psychotherapy by the leading public experts, we have to record
other important acknowledgments.
Thus R. R. Grinker and L. A. Spiegel in their new book Men Under
Stress say:
"Dealing with groups has a positive value in that the group more
nearly approximates the state of the human being in his natural sur-
roundings, as a gregarious animal seeking a satisfactory niche in his
social setting. His inhibitions and repressions are motivated by the
mores of the group. By working out his problems in a small way, he
should be theoretically able to face the larger group that is his world
in an easier manner."
Even with the qualifying limitation of the word "theoretically", the
above quotation appears to be quite a step forward in favor of group thera-
py, considering Grinker's pre-war position of strict psychoanalyst.
There is another testimonial one of many from official or semi-
official sources. To Howard P. Rome was given the opportunity of writing
a special chapter on "Military Group Psychotherapy" in the Manual of
Military Neuropsychiatry (1944). Nobody interested in group therapy
should omit this brief and concentrated report on the application of group
psychotherapy methods for the streamlining of (convalescent) neurotic
battle casualties; and this holds good no matter how much the views of
some group therapists may differ on the question as to whether this kind
of psychologic "regimentation", as it were, of the souls should be called
psychotherapy. (In parenthesis it may be noted that Rome (page 564)
shows himself strongly opposed to the deadening force oj routine:
". . . occupational therapy is too often as detrimental as boredom
since it stifles initiative and incentive, and leads to discontentment.
Only creative, satisfying (italics mine, J. I. M.) activity [with a mili-
tary reference] should be a part of a convalescent program."
Does that not sound almost like a eulogy to Moreno's spontaneity? Thus
confirming the same "shifting of the accent" on the group-centered, inter-
actional 9 type of group psychotherapy even within such a strict lecture pro-
gram as Rome's the shift which we had pointed to in the foregoing section.
Maybe some of the readers will agree with the feeling of this writer:
that the fact that hundreds of thousands of servicemen and women and
9 See Fig. 2. and 3.
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512 GROUP PSYCHOTHERAPY
officers and, moreover, thousands of physicians in the Medical Corps have
personally experienced and obtained at least a glimpse of group psycho-
therapy "in action", might prove almost more important for the future
significance of this branch of medicine within our national body than the
existence of any number of printed articles and acknowledgments, valuable
as they are.
* * *
There is still another rather surprising instance where group psycho-
therapy within the war has shown its mettle in the "guise", as it were,
of an individual psychotherapy,
We read in the report on "War Neuroses in N. Africa" by Grinker,
or in the extract therefrom "Narcosynthesis, a Psychotherapeutic Method
for Acute War Neuroses", the following excellent, highly dramatic descrip-
tion (page 3) :
". , , frequently, especially among the milder anxiety states the patient
does not live out (italics mine) the scene in the present but tells it as
a story . . . ,"
and especially on page 4:
". , . some patients who talk constantly throughout the [drug induced
(J. I. M.)] session 'to their friends', become blocked at certain points
of emotional height.
The therapist then plays the part (italics mine, J. I. M. )of the
friend stepping, as it were, into the battle scene proper in an active
role. He discusses plans of action, ways of evacuating the wounded
comrades or whatever is cogent to the particular situation in order to
further the progress of events in hand."
Could anyone familiar with for instance psychodramatic group psy-
chotherapy devise the picture of an "auxiliary ego" truer to form than this
individual (narco-synthetic) psychotherapist who has turned group thera-
pistas it were "in spite of himself"?
We have permitted ourselves to call attention to such choice morsels
and interesting examples of undiluted group psychotherapy "in sheep's
dothing" only because otherwise they would have passed unnoticed; we
are sure that the reader will get his fill of frank and unadulterated group
psychotherapy applied during wartime from the listed literature.
As an unusual aspect of the application of group psychotherapy to
modern war, 10 we want to list here the plan for "mass" psychotherapy as
This paper is quoted here specifically in view of the significance its topic may
274
HISTORICAL SURVEY 513
preventive psychiatry (of newly inducted soldiers) as presented by R. R.
Cohen ("Factors in Adjustment to Army Life . . ." etc., in War Medicine,
vol 5, pp. 83-91 Feb. 1944). As far as we can see Cohen's "plan" con-
stitutes merely a highly schematized "prophylaxis" for rookies by means
of lectures, for instance against homesickness and other psychic ailments
of undigested Army life, lectures with posters and schematic pictures, but,
as it seems, even without discussion. Still, no matter how "rough" this
indoctrination may appear and how far from what many might be inclined
to call psychotherapy, we have to try to learn from it, especially as the
author reports that his preventively "psycho"-treated soldiers' group was
found by the Army superior to controls.
Another interesting war item may be quoted: S. Sherman's "System of
combined individual and group therapy as used in medical program for
merchant seamen." (In Am. /. Psychiatry, vol. 100, pp. 127-130, July
1943.)
In closing this section on the inter-relation of group psychotherapy and
this war, it might be of interest to know what E. A. Strecker stated: "The
extensive use of group therapy has been one of the innovations of World
War II." It was used, however, Strecker goes on to say "in World War I
by Strecker and Hadfield". Hereto might be added what Dr. McPherson
stated in the discussion to S. B. Hadden's paper on group psychotherapy
(Transact. Amer, Neurological Assn., 1943, pp, 132-135): "Sidney Schwab
in the last (1914) war demonstrated how effectively the group can be used
as an adjunct to therapy with the individual." 11 Of course the dimensions
which the attempts at cures by group psychotherapy have assumed in this
war differ as fundamentally from those in the last war as the dimensions
of the wars themselves. But that refers not only to the numerical extension
and expansion of the application of group psychotherapy; it has under-
gone a deep change itself largely through the introduction of the "dramic"
inter-actional and koinotropic features.
assume in case the United States continues universal (selective) compulsory military
and naval training.
"The writer regrets having been unable to locate so far an original paper by
Schwab describing this experience of his. This entire historical topic of priority may
be as it will seem to many a reader of purely academic interest. However, it de-
serves mention hi a sketch on development of group psychotherapy.
275
514 GROUP PSYCHOTHERAPY
NON-MILITARY DEVELOPMENT OF GROUP PSYCHOTHERAPY DURING
THE SECOND WORLD WAR
Small as most "civilian affairs" have appeared and have been pre-
sented to the public eye during the volcanic days of the war, still: "life
had to go on." And so has the small, still way of science, pure and applied.
Purely theoretical and abstract research going on before and during the
war contrbuted to the development and self-clarification of group psycho-
therapy.
This again is reflected in the bibliography, We h$ve two main parts
to consider: that brought forth by the psycKodramatic-sociometric school,
which in itself produced, approximately within these last five years, the
bulk of group-psychotherapeutic titles. Aside from J. L. Moreno's, own
fundamental monographs, I want to mention here specifically Z. Toeman's
"Role Analysis and Audience Structure" 1944, 1 commend this to the reader's
attention not only because it places "Special Emphasis on Problems of Mili-
tary Adjustment" and thus constitutes another instance of the contribution
of psychodramatic group psychotherapy to the war effort of the democra-
cies but even more because it represents an almost classic example of the
essence of the dramic-interactional type of group psychotherapy and its
most important aspects and techniques. As said before the publications
connected especially with the psychodramatic-sociometric sector of group
psychotherapy have become so numerous as to transcend any possibility
of detailed review here. In the other, the more "didactic" sector of group-
psychotherapeutic literature, I wish to name also only a few which appear
as of special theoretical interest: S. B. Hadden's "Group Psychotherapy,
Superior Method of Treating Larger Numbers of Neurotic Patients" (July,
1944); L. A. Schwartz's, "Group Psychotherapy in the War Neuroses"
(1945); and further, two contributions from England: W. R. Bion and
J. Rickmans, "Intragroup Tensions in Therapy: Their Study as a Task
of the Group"; and Donald Blair's, "Group Psychotherapy for War Neu-
roses", both published in 1943. (Of the latter, American readers find an
extensive and well orienting review in Psychosomatic Medicine, vol 6, Jan.
1944, pp. 100.) The above titles are pointed out mostly for their theoretical
interest or/and as most typical of the "didactic" approach. Still, for the
rest of the list goes the same as was said before concerning the psycho-
dramatic sector, namely, that all of these reports and research papers de-
serve attention.
276
HISTORICAL SURVEY SIS
VARIOUS PROBLEMS AND SPECIFIC FIELDS IN MODERN GROUP
PSYCHOTHERAPY
There is a project, still in its initial stages, the introduction of group
psychotherapy in state hospitals. Originally, when group psychotherapy
was conceived by many from the point of view of "multiplying" the reach
of the individual psychotherapist, there arose a great hope with many a
well-meaning friend of the "underprivileged" the "under-treated" mental
state hospital patients, who constituted a mass of approximately half a
million in the continental U. S. A. alone before World War II! There
have been, however as far as this writer has been able to unearth only
relatively few papers about this important question, aside from stray re-
marks in general articles. Only as an example we mention the interesting
more recent paper: G. L. Perkins' "Psychotherapeutic Aspects of State
Hospital Psychiatry" (June 1943. Highly significant are the discussion
remarks about it by Dr. Charles W, Read (Elgins State Hospital, Illinois) :
". . . We have so little time to be spent on the individual patient. We want
to get things done in a hurry. . . ." How true, how frank!
It is true, of course, that not only articles have been written on this
topic but that also some practical attempts have been made to cope with
this rather deficient situation where group psychotherapy would truly come
fully into its am. Was it the rapid intervention of the mechanical device
of the various shock therapies (which at best could support but never sup-
plant group and individual psychotherapy if real healing is aimed at)?
Was it the utter war-increased shortage of doctors, let alone of experi-
enced psychotherapists in the large psychiatric hospitals? In any case, this
field of group psychotherapy so far, it seems, has remained sadly under-
developedmildly speaking. Here especially, in the opinion of this writer,
the "dramic" approach, if properly executed, could be expected to yield
the best results and at the same time, would present the most economic
procedure.
Projects on such a scale require the training of adequate personnel,
especially the training of directors. According to Moreno a director has
three functions, he is a producer, a therapeutic agent and a social analyst.
These qualifications should fulfill the requirements for directing any group
psychotherapeutic as well as psychodramatic sessions.
One thing is certain: efficient Group Psychotherapy is not a matter
of a few medical (or not medical) geniuses or men of peculiar skill and
gifts. It can be learned; and so it must. And the ones who alone will be
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516 GROUP PSYCHOTHERAPY
able to, and should set up the standards and the schooling devices for the
growing number, throughout the country and the continents, of much need-
ed Group Psychotherapists are, no doubt, the heads and the co-workers
of the existing successful group-psychotherapeutic units.
Another problem of greatest general interest appears to be that of the
increased opportunity which modern Group Psychotherapy (as compared
with individual psychotherapy) offers for confronting and, also, adapting
the neurotic and the psychotic patient to the presence of the opposite sex.
It seems obvious that this far-reaching problem is better solvable in
the sphere of group psychotherapeutic (especially in that of the inter-
actional and dramic type) than in mere verbalistic devices of individual
therapy alone. This question is, no doubt, so vast that we can merely point
it out. We therefore limit ourselves to quote here from the report by
J. Bierer (England) on "A New Form of Group Psychotherapy". ", . . the
complication that might have arisen but did not (italics mine, J. I. M.)
from mixing of sexes." And we would not pass up here the words said, in
the discussion of that same paper, by T. P. Rees: "... I wonder to what
extent the improvement noted by Dr. Bierer in his patients was due to
the facilities provided for the free intermingling of the sexes. I am sure
that segregation of the sexes at present (is) overdone in our (British M)
mental hospitals."
Last but not least, a few words about the progress made by Group
Psychotherapy in using other than verbal techniques. The use of puppet
shows (specially an children's Group Psychotherapy) is widely known. The
employment of moving pictures along with or in addition to, verbal-dramatic
devices, has become known in the last years, especially in Psychodramatics
but also in connection with the (military) narco-synthetic methods (Grinker
et al.).
We wish here to mention what seems to be less known namely, the
use of music (Moreno's Psychomusic) in connection with specific form of
Group Psychotherapy. See: The Impromptu Orchestra, in Impromptu
periodical, vol. I, No, 2, 1931.
Of no less interest but, probably, still less known is the group-psycho-
therapeutic factor involved in the application of the (so-called "fine") Arts
painting, sculpturing, etc. The very outstanding work of Ernest Zierer,
in his Creative (Art) Therapy -although working generally with the indi-
vidual patient and using Color Tensions and the feeling of Integration as
main factors employs to a considerable extent also group devices: collec-
278
HISTORICAL SURVEY 517
live wall picture painting, and certain group instruction and discussion
of the students' community.
A last word may be appropriate about the passive role, so to speak,
played by Group Psychotherapy in recent time: we mean by that the evalu-
ation it has obtained as one of the "Projective Methods" available to human
psychology for the gauging of "personality" factors. See: Helen Sargent,
"Projective Methods, their origin, theory and application in Personality
Studies". (Psychological Bulletin, May 1945).
A last question: Is it possible, is it even necessary, to measure with a
purely statistical yardstick the extent of the progress which our method has
made in the last ten or fifteen years in the awareness of it both among the
educated, and of the general public?
There are, certainly, still entire "blacked out" spots in our map, prov-
inces, as it were, both geographically and educationally speaking where
dl too little, if anything was ever heard yet of the very existence of Group
Psychotherapy.
Is it significant (let us ask ourselves frankly) to note that in two of
the newest books that have appeared in 1945 in the field of Psychiatry in
the U.S.A. (Kainosh, L. J. and Zucker, E. M., "A Handbook of Psy-
chiatry") in its 302 pages does not mention Group Psychotherapy at all
Whereas Sadler's "Modern Psychiatry" has on page 750, under the headline
"Psychiatric Socialization" the following text: ". . . these isolated person-
alities should be encouraged to seek membership in those community groups
engaged in various social, civic and philanthropic activities." Again, no
mention, otherwise of Group Psychotherapy as a modern psychiatric agent.
Is such overlooking wholly the matter of "Ignorance, pure and simple",
of lack of knowledge on the part of these and other authors? Should we,
Group Psychotherapists, not conclude inversely that Group Psychotherapy
as an entirety has so far done not enough to achieve renown in some more
remote and/or "conservative" quarters?
ANALYSIS OF BIBLIOGRAPHY
Only such group researches are referred to in this survey which have
the therapy of the group and the change of its dynamic structure as its
main focus. For this reason, many sociological and sodo-psychological titles
of merit are not included.
On the basis of the bibliography appended the development of group
psychotherapies can be divided into six periods: first period, from 1906-1914
279
518 GROUP PSYCHOTHERAPY
(early work by J. J. Pratt and J. L. Moreno); second period, 1914-1919,
First World War (contributions by Pratt and Moreno); third
period, 1919-1932; up to the historic conference on Group Method in
Philadelphia (contributions from Moreno, Pratt, E, W. Lazelle, 1921, and
Trigant Burrow, 1924); fourth period, 1932-1934, up to appearance of
Moreno's Who Shall Survive? (contributions from Moreno, Pratt, Helen H.
Jennings, 1931, L. C. Marsh, 1931, Lazelle, Burrow); fifth period, 1934-
1940 (Moreno, Jennings, Marsh, Burrow, Winifred Richmond, 1936, M.
Schroeder, 1936, Paul Schilder, 1936, Louis Wender, 1936, S. R. Slavson,
1937, Shepard Wolman, 1937, Lauretta Bender, 1937, Newell E. Kephart,
1938, Kurt Lewin, 1938, Ronald LIppitt, 1938, Ernest Fantel, 1939,
Frank Curran, 1939, Howard Rowland, 1939, Joseph Sargent, 1939, Anita
M. Uhl, 1939, Bruno Solby, 1939, J. G. Franz, 1940, E. N. Snowden, 1940 ;
Leona M. Kerstetter, 1940, Ruth Bordon, 1940, Leslie D. Zeleny, 1940) ;
sixth period, 1940-1945, Second World War; during this period a con-
siderable literature developed, only a few of the newcomers are mentioned
(Margaret Hagan, 1941, Frances Herriott, 1941, William S. Dunkin, 1941,
I. M. Altshuler, 1941, P. L. Smith, 1941, John K. Fischel, 1942, Lawson G.
Lowrie, 1942, Fritz Redl, 1942, Samuel B. Hadden, 1942, Z. Toeman, 1942,
Nathan W. Ackerman, 1943, Howard P. Rome, 1943, Stephen Sherman,
1943, Edward A. Strecker, 1943, Rose Cologne, 1943, Abraham Low, 1943,
W. R. Bion and T. Rickman, 1943, T. P. Rees, 1943, 1. Bierer, 1943, D. Blair,
1943, Florence B. Moreno, 1944).
SUMMARY
In this paper we endeavored to show:
1. The roots of Group Psychotherapy as a yet unsystematized, pre-
sdentific activity, an attempt of self cure of early human groups; going,
probably, even deeper than those of "pre-historic" individual psychotherapy.
2. The first emergence of the terms "Psychotherapy" (1803) and
"Group Psychotherapy" (1931) is traced.
3. An attempt is made to show the "mother soil" for the originating
of modern "Group Psychotherapy" at the time of its start.
4. The "Precursors" and originators of the earliest and, at the same
time, most typical "schools" of Group Psychotherapy: the American, J. H.
Pratt ("Thought Control Classes", Boston, Mass.) and (the Europe born)
J. L. Moreno (Sociometry-based Group Psychotherapy and Psychodrama,
Beacon, N. Y. and New York City).
280
* HISTORICAL SURVEY 519
5. The Pioneer Period.
6. The first historian of Group Psychotherapy, G. W. Thomas (1943).
His categorization of Group Psychotherapy (merely "analytic" vs. "repres-
sive-inspirational") recorded, evaluated and criticized.
7. Other viewpoints of necessary categorization are brought forth.
8. Tendencies within the various Schools of Group Psychotherapy;
is there a "shift" towards the interactional-koinotropic type of Group
Psychotherapy?
9. The Development during the War (1939-1941-1945); necessity of
statistically founded self-criticism of Group Psychotherapy as a whole and
of its various "schools" comparatively. Instances of achievements of Group
Psychotherapy in this war emergency. Group Psychotherapy "in the guise"
of Individual Psychotherapy. Group Psychotherapy as a means of preventive
(military) psychiatry. Group Psychotherapy budding in World War I.
10. Non-military development of Group Psychotherapy during the
second World War.
11. Various problems and specific fields in Modern Group Psycho-
therapy: Administrative and allied problems: I. Application of Group
Psychotherapy in state and other larger mental hospitals. II. The problem
of qualification and training of group-psychotherapeutic directors. Thera-
peutic problems and technics: III. The confrontation of the (neurotic and
psychotic) patient with the opposite sex is apparently better solved or
at least better solvable with the aid of Group Psychotherapy than by
individual therapy alone. IV. Music and Group Psychotherapy, V. Art
(the "fine arts") and Group Psychotherapy.
CONCLUSION
Group psychotherapy is "marching on." However, it appears that it
is not being applied yet, either in North America or anywhere else, in pro-
portion to its already proven, and to its potential usefulness.
One of possibly the best means, both for self-clarification among group
psychotherapists in the broadest sense (i.e. all those actively interested in
group psychotherapy) appears to this writer to be the convening of a well
prepared national (and later an international) congress for the discussion
of all current problems arising in this field in the post-war period.
281
S20
GROUP PSYCHOTHERAPY
SELECTED BIBLIOGRAPHY
1803
1, Johann Christian Reil
1816
2. J. Chr. Reil and
Hofbauer
1906
3. Joseph H. Pratt
1907
4. Joseph H, Pratt
1908
5. Joseph H. Pratt
6. Jacob L. Moreno
7. Jacob L. Moreno
8. Hermann Ebbinghaus
1909
9. Hugo Muensterberg
1911
10. G. B, Cutten
11, J. L. Moreno
12. J. H. Pratt
1914
13. J, L. Moreno
Rapsodien ueber die Anwendung d. psychisch.
Curmethode auf d, Geisteszerruettungen.
Halle a. Saale (Rhapsodies on the applica-
tion of the psychic healing method to ment.
disease).
Beitraege z, Befoerderung einer Curmethode
auf psychisch. Wege, Wien. (contributions to
advancement of a psychic curative method),
Vienna. 2 vol.
The home sanatorium treatment of consump-
tion; Johns Hopkins Hosp. Bulletin, 17: 140;
Discuss, pg. 1S8.
The class method of treating consumption in
the homes of the poor; J. Amer. Med. Assoc.,
49: 7SS.
Results obtained in treatment of pulmon.
tuberculosis by the class method; Brit. Med.
Jin., 2: 1070.
Homo Juvenis (in German) ; Vienna.
Das Kinderreich (the children's realm) ; later
re-edited under the title: (see No. 28) Das
Koenigreich der Kinder. Vienna.
Abriss der Psychologic; Veit & Co., Leipzig.
(abstract of psychology).
Psychotherapy; Lond., New York: Moffat,
Yard & Co. 8 (see p. 354)
Three thousand years of mental healing;
New York. 8
Die Gottheit als Komoediant (the godhead
as comedian with emphasis on "Audience
catharsis); Vienna. See: No. 20a.
The dass method in the home treatment of
tuberculosis, and what it has accomplished;
Trans. Amer. Climatol. Assoc., 27: 87.
Einladung zu einer Begegnung (invitation to
a meeting), Vienna, Anzengruber Verlag
(publisher).
282
HISTORICAL SURVEY
521
1915
14. J. L. Moreno
15. Johannes H. Sckultz
1916
16. J. L. Moreno
1917
17. S. E. Jelliffe
18. J. H. Pratt
1918
19. J. L. Moreno
1919
20. J. L. Moreno
20a. J. L. Moreno
1920
21. J. L. Moreno
22. E. Magnin
23. Hermann Detzner
24. E. E. Robinson
1921
25. E. W. Lazell
26. M. Cuipin
1922
27. J. L. Moreno
Das Schweigen (Silence), Vienna, Anzen-
gruber Verlag.
Wege und Ziele der Psychotherapie (ways
and aims of psy'therapy), in: Therapeut.
Monatshefte, XXIX, August, pg. 443.
Das Testament des Schweigens (philosophy
of silence), Vienna, Anzengruber Verlag.
Psychotherapy and the drama, in: N. Y.
Medic. Journ., CVI (1917) pg. 442-47.
The tuberculosis class. An experiment in
home treatment; in: Proceed. N. Y. Confer-
ence, Hosp. Soc. Service Assoc. of N. Y.
City, v. 4: 49.
Die Gottheit als Autor (the godhead as
author) Vienna, Anzengruber Verlag; ap-
peared in the periodical "Daimon".
Die Gottheit als Redner (the godhead as
orator) Vienna, Anzengruber Verlag; ap-
peared in "Daimon".
Die Gottheit als Komoediant (re-publica-
tion), Vienna, Anzengruber Verlag, appeared
in "Daimon"). See: No. 11, this Bibliogr.
Das Testament des Vaters (The words of
the father), Berlin - Potsdam, Kiepenheuer
Verlag, 145 pg.
Devant le mystere de la nevrose; . . . gueri-
son des cas reputes incurables. Paris, 12.
Vier Jahre unter Kannibalen Neuguineas
(4 years among cannibals, New Guinea),
Berlin, A. Scherl (publ. comp.) 338 pg.
The compensatory function of make-believe
play; Psycholog. Review, 27: 434-38,
The group treatment of dementia praecox.
Psychoanal. Rev,, 8: 168.
The present position in psychotherapy; Lan-
cet (London) v. 2: 684-87.
Rede ueber den Augenblick (discourse on the
moment), Potsdam, Kiepenheuer Verlag.
283
522
GROUP PSYCHOTHERAPY
28. J. L. Moreno
29. J. H. Pratt
1923
30. J. L. Moreno
1924
31. Trigant Burrow
32. Ernst Zierer
33. Ernst Zierer
1925
34. J. L. Moreno
1926
35. J.tLHadfidd
1927
36. T. Burrow
37. T. Burrow
38. H. 0. Syz
1928
39. J, L. Moreno
40. T. Burrow
41. H. 0. Syz
1929
42. J. L. Moreno
Der Koeriigsroman (the King's Novel);
Potsdam, Verlag des Vaters (G. Kiepenheuer
Verlag) 8 255 pg. (Re-publish.: 1923).
The principles of the class treatment and
their application to various chronic diseases;
in: Hospit. Soc. Setv., 6: 401.
Das Stegreiftheater (Spontaneity theater);
Potsdam. G. Kiepenheuer Verlag, 100 pg.
Social Images versus reality; Journ. Abnorm.
Psychology, 19: 230.
Absolute Tiefenanschauung (Non-associative
art evaluation) ; an essay on theory of sensa-
tion and art. Stockholm, Akelund Olina.
Kunst und Weltgesetz (Art and Universal
Laws); ibidem. 1923; (1924).
Rede vor dem Richter (speech before the
judge) with section on Die Dramatisierte
Zeitung (the living newspaper), G. Kiepen-
heuer Verlag, Berlin.
Treatment by suggestion and persuasion in
functional nerv. diseases; New York, Oxford
University Press. 80 pg.
The group method of analysis; Psychoanalyt.
Rev., 14: 268.
The Social Basis of Consciousness, New
York, Harcourt, Brace & Co., 274 pg.
On a social approach to neurotic conditions;
in; Journ. Nerv. & Ment. Diseas., 66: 601.
"Impromptu School"; paper published by
The Plymouth Institute, Brooklyn, N. Y.
The basis of group analysis, or analysis of
reactions of normal and neurotic individuals;
Brit. J. Med. Psychol, 8: 198.
Remarks on group analysis; Amer. Jrn.
Psychiat., 8: 141.
Standardization vs. Impromptu; N. Y. City,
Moreno Laboratories, Inc. (publish,).
284
HISTORICAL SURVEY
523
1930
43. T. Burrow
44. E. W. Lazell
1931
45. J. L. Moreno
46. J. L. Moreno
47. J. L. Moreno
48. J. L. Moreno
49. J, L. Moreno
50. J. L. Moreno
51. J. L. Moreno
52. J. L. Moreno
53. J. L. Moreno
54. J. L. Moreno
55. J. L. Moreno
(1932)
55a. J. L. Moreno
So-called "normal" social relationships ex-
pressed in individuals and group, and their
bearing on problems of neurotic disharmo-
nies; Amer. J. Psychiat., 10: 101.
Group psychic treatment of dementia praecox
by lectures in ment. reeducation; U. S. Vet.
Bureau Med. Bull., 6: 733.
Group Method and Group Psychotherapy;
Beacon House Inc., Sociometry Monographs,
No. 5. 104 pages, charts, sociograms. (Pre-
vious editions: "Plan for transforming a
prison into a socialized community", also
"Application of the Group Method of Appli-
cation").
Editorial (Three principles of publication)
of "Impromptu", editor: J. L. Moreno; vol.
I, No. 1, pg, 3, January 1931, New York.
Ave Creator; ibidem, pg. 4-5.
The impromptu state; ibidem, pg. 9,
The new name (on the evolution of the im-
promptu concept, etc.); ibidem, pg. 10-11.
Dramaturgy and creaturgy; ibid., pg. 12-13.
The creative act; ibidem, pg. 18-19 (essen-
tials on the psychology of impromptu and
spontaneity).
Towards a curriculum of the impromptu play
school (I, II, III); ibidem, pg. 20-23 (on
the theory, history, techniques of the original
Vienna children's spontaneity garden and
stage playing; Elizabeth Bergner; etc.)
The creative revolution, in: "Impromptu"
(periodical), vol. I, No. 2, April 1931, pg. 4.
The inauguration of impromptu (announce-
ment of the living newspaper) ; ibidem, pg. 3.
The impromptu orchestra (On spontaneity
in music) ; ibidem, pg. 7-9.
Round Table Conference: "The application
of the group method to the classification of
prisoners", a pamphlet released by the Na-
tional Committee on Prisons and Prison
Labor, New York.
285
524
GROUP PSYCHOTHERAPY
1931
56. Helen C. Jennings
57. L. C. Marsh
1933
58. L. C. Marsh
59. J. L. Moreno, with
discussion by
William A. White
1934
60. J* L. Moreno, with
foreword by
William A. White
61. J. H. Pratt
1935
62. W. Rhoades
63. L. C. Marsh
64, Gardner Murphy
64a. H. Detzner
65a. Jos. L Meiers, and
M. Eliash
1936
65. J. L. Moreno, and
Helen H. Jennlng
Experiments in impromptu analysis; in:
"Impromptu" (periodical) Vol. I, No. 1,'pg.
26-27. January 1931.
Group treatment of psychoses by psycho-
logical equivalent of the revival; Ment. Hy-
giene, 15: 328.
Experiment in group treatment of patients
at Worcester State Hospital; Ment. Hygiene,
17: 396.
Psychological organization of groups in the
community. 57th Yearbook on Mental De-
ficiency, Boston, Mass., 1933.
Who shall survive? A new approach to the
problem of human interrelations. Nervous
and Mental Disease Publish. Co., Washing-
ton, D. C. 477 pg.
The influence of emotions in the causation
and cure of psychoneuroses; in: Interna-
tional Clinics, v. 4: pg. 1.
Group training in thought control for reliev-
ing nervous disorders; Ment. Hygiene, 19:
373.
Group therapy and psychiatric clinic; in:
J. Nerv. & Ment. Dis., 82: 381.
A review of J. L. Moreno, "Who shall sur-
vive?", in: The Journ. of Social Psychology,
August 1935.
Moeurs et coutumes des papous, quatre ans
chez les cannibales de Nouv. Guinea; Paris,
Payot, publish. (French edition, No. 24, this
Bibliogr.).
Sur la theorie de consultation d'enfants
arrieres; Revue OSE, Paris, 1935, Novem-
bre (On the theory of mental guidance work
with backward children).
Spontaneity training; in Sodometric Review,
Hudson, N. Y., 1936 (contains description
of early therapeutic film presented first at
meeting of American Psychiatric Association,
May's, 1935, Washington, D. C.).
286
HISTORICAL SURVEY
525
66. Arnold Boldt
67. Joan H. Criswell
67a. Helen H, Jennings
68. J. L. Moreno
69. Winifred Richmond
70. Paul SckUder
71. Louis Wender
72. M. G. Sckraeder
1937
73. Lauretta Bender
74. Bendix-Ebbell
75. R. W. Buck
76. M. N.
J. J. Stafano,
J. S. Rogerson,
and F. H.
77. J. L. Moreno
Ueber die Stellung & Bedeutung der "Papso-
dien ueb. d. Anwendung der psych. Cur-
methode auf Geisteszerruett." v. J. Chr, Reil
in der geschichte der Psychiatrie (On the
position in, and the significance for the his-
tory of Psychiatry, of the "Rhapsodies , . ."
by J. Chr, Reil) in "Abhandlungen z. Ges-
chichte d. Medizin & Naturwiss., Heft 12,
1936, Berlin, E. Ebering (publisher). See
pages 102, 109, 138. Compare No. 1, this
Bibliogr.
Sociometric analysis of negro-white groups;
in: Sociometric Rev. (N. Y. State Training
School f. Girls) Hudson, N. Y., 1936.
See No. 64, this Bibliogr.
Organization of the social atom; in: Socio-
metric Rev., Hudson, N. Y., 1936.
Sociometric tests in a training school for
nurses; in: Sociometric Rev., Hudson, N, Y.,
1936.
The analysis of ideologies as a psychothera-
peutic method, especially in group treatment;
Amer. Jrn. Psychiat. 93: 601.
Dynamics of group psychotherapy and its
application; J. Nerv. & Ment Dis., 84: 54.
Group psychotherapy in state hospital; Elgin
State Hospital (publication) vol. 2: 174.
Group activities on children's ward as meth-
ods of psychotherapy; Amer. J. Psychiatry,
93: 1151.
The papyrus "Ebers", the greatest Egyptian
medical document; translated by B. Ebbell,
N. Y., Oxford University Press, 1937. See
espec.: pg. 15.
Class method in treatment of essential hyper-
tension; In: Ann. Int. Med., 11: 514,
Value of group psychological procedures in
treatment of peptic ulcer; in: Amer. J.
Digest. Dis. and Nutrition, 3: 813.
Interpersonal therapy and the psychopathol-
ogy of inter-personal relations; in: Soci-
ometry, vol. I, part I, July-October.
287
526
GROUP PSYCHOTHERAPY
78. P. Schilder
79. Shepard Wolman
80. Gardner Murphy
81. Gardner Murphy,
Lois B. Murphy,
and T. M. Newcomb
82. Helen H. Jennings
85.
86.
87.
88.
Psychotherapy, New York, W. W. Norton
& Co.
Sociometric planning of a new community;
in: Sodometry, v. I, part I, July-Oct.
The mind is a stage; Forum Magazine, May
1937
Chapter on sociometry, in: Experimental
Psychology, N. Y., Harper & Bros.
Structure of leadership development and
sphere of influence; Sociometry, v. I, part I,
July-Oct.
Social attraction patterns in a rural village:
a prelim, report; Sociometry, v. I, part I,
July-Oct.
A review of J. L Moreno: "Who shall sur-
vive?"; Amer. Sociolog. Rev., vol. 2, No. 4,
August.
Theodore M. Newcomb Intra-family relationships in attitude; Sod-
ometry, v. I, part I, July-Oct.
83. George A. Lundberg
84. George A. Lundberg
1938
Helen H. Jennnigs,
with J. L. Moreno
Newell C. Kephart
Kurt Lewin and
Ronald Lippitt
Statistics of social configurations; Sociom-
etry, v. 1, part 2, Jan.- April.
A method of heightening social adjustment
in an institutional group; Amer. J. Orthopsy-
chiat., vol III, No. 4.
An experimental approach to the study of
autocracy and democracy: a prelimin. note;
Sociometry, v. 1, part 2, Jan.-April.
See: No. 86, this Bibliogr.
The racial saturation point in the American
community; address read before the Amer.
Assoc. f. the Advanc. of Science, Ottawa,
June 1938.
1939
Alcoholics Anonymous Works Publish. Company, N. Y., pg. 400.
Alcoholics Anonymous Introduction to "A. A."; New Jersey group
of A. A. (publishers), Community House,
Mead Str., South Orange, N. J.
The economic factor in disorders of behavior;
Amer. J. Orthopsychiat, 9: 102.
A sociometric structure of race cleavage in
the class room; Archives of Psychology,
v. 33, No. 235.
The drama as a therapeutic measure in ado-
lescence; Am. J. Orthopsychiat, 9: 1:215.
288
88a. J. L. Moreno
89. J. L. Moreno
90.
91.
92. T. Burrow
93, John H. CrisweU
94, Frank J. Curran
HISTORICAL SURVEY
527
95. Ernest Fantel
96. J. G. Franz
97. Kurt Goldstein
98. B. Gabriel
99. H. I. Harris
100. Helen H. Jennings
101. Lawson G. Lowrie
102. J. L. Moreno
103. J. L. Moreno, with
Jos. Sargent and
Anita M. Uhl
104. J. L. Moreno
105. Howard Rowland
106. P. Schilder
107. W. D. SUkworth
107a. Joseph Sargent
107b. Anita M. Uhl
1940
108. I. M. Altshuler
109. Ruth Borden
Note on sociometric work in a mental hospi-
tal; Sociometry, v. II, No. 2, April, p. 107.
Spontaneity training in public speaking: a
prelimin. report; Sociometry, v. II, No, 3,
July.
The Organism, A holistic approach to
biology, derived from patholog. data in Man.
Foreword: Prof. K. S. Lashley; New York
and Cincinnati, The Amer. Book Co., 1939.
An experiment in group treatment; Am. J.
Orthopsychiat, 9: 146.
Efficient psychotherapy for the large out-
patient clinic; New England J, Med., 221:
Pg- 1-
Quantitative aspects of tele-relationships in
a community; Sociometry, v. II, No. 4,
October.
Trends in therapy; Am. J. Orthopsychiat, 9:
699.
Psychodramatic shock therapy a sociomet-
ric approach to the problem of ment. dis-
orders; Sociometry, v. II, No. 1, January.
Normal and abnormal characteristics of per-
formance patterns; Sociometry, v. II, No 4,
October.
Creativity and the cultural conserves, with
special reference to musical expression;
Sociometry, v. II, No. 2, April.
Friendship patterns in a mental hospital; in:
Psychiatry, vol. II, No. 3, August.
Results and problems of group psychotherapy
in severe neuroses; Ment. Hygiene, 23: 87,
1939.
New approach to psychotherapy in chronic
alcoholism; Journ. Lancet (Minneapolis) 59:
312.
See 103, this Bibliogr.
One year's experience with group psycho-
therapy; Ment. Hygiene, 24: 190.
The use of the psychodrama in an institution
for delinquent girls; Sociometry, v. Ill, No.
1, January.
289
S28
GROUP PSYCHOTHERAPY
110. F. Stuart Chapin
111. Stuart C.Dodd
112. J. G. Franz
113. Frances Herriott
114. Leona Kerstetter
with Joseph Sargent
US. J. L. Moreno
116. J. L. Moreno
117. J. L. Moreno
118. J. L. Moreno
119. J. L. Moreno with
Helen H. Jennings
and Joseph Sargent
120. Mary L. Nortkway
121. Louise Price
121a.
122.
123.
124.
125.
126.
127.
128:
Joseph Sargent
Bruno Solby
Paul Schilder
Paul Schilder
S. R. Slavson
E. N. Snowden
S. S. Stirt
Louis Wender
Trends in sociometrics and critique; Soci-
ometry, v. Ill, No. 3, July, and No. 4
October.
The interrelation matrix; Sociometry, v. Ill,
No. lj January.
The place of psychodrama in research; Sod-
metry, v. Ill, No. 1, January.
Diagnostic examination of patients on the
psychodrama stage; Sociometry, v. Ill, No,
4, October.
Reassignment therapy in the class room as a
preventive measure in juvenile delinquency;
Sociometry, v. Ill, No. 3, July.
Psychodramatic treatment of marriage prob-
lems; Sociometry, v. Ill, No. 1, January.
Psychodramatic treatment of psychoses; Soci-
ometry, v. Ill, No. 2, April.
Mental catharsis and the psychodrama; Soci-
ometry, vol. II, No, 3, July.
A frame for reference for testing the social
investigator; Sociometry, v. Ill, No. 4,
October.
Time as quantitative index of inter-personal
relations; Sociometry, v. Ill, No. 1, January.
Appraisal of the social development of chil-
dren at a summer camp; University of
Toronto Studies, Psychology Series, vol. 1,
No. 1.
Sociometric Practices on the Campus; Soci-
ometry, v. Ill, No, 2 ; April.
See: Nos. 114 and 119, this Bibliogr.
Note on psychodrama in a reformatory:
Sociometry, v. Ill, No. 2, April,
Introductory remarks on groups, Jrn. Social
Psychology, 12: 83.
Social organization and psychotherapy, Amer.
Jrn. Orthopsychiat., 10: 911.
Group therapy; Ment. Hygiene, 24: 36.
Mass psychotherapy; Lancet (London), v.
2: 769.
Overt mass masturbation in class room,
Amer. J. Orthopsychiat., 10: 801.
Group psychotherapy: study of its applica-
tion, Psychiatr. Quarterly, 14: 708-14.
290
HISTORICAL SURVEY
529
129. Leslie D. Zeleny
130. Leslie D. Zeleny
131. Leslie D. Zeleny
132. Leslie D. Zeleny
133. Leslie D. Zeleny
133a. W. Brown
19.41
134. Alcoholics Anonymous
135. Leonard S. Cottrell, Jr.
and Ruth Gallagher
136. Frank J. Curran
and Paul Schilder
137. William S. Dunkin
13 7a. Ruth Gallagher
138. Margaret Eagan with
Frances Herriott
138a. Frances Herriott
139. Philip T. Hodgskin
140. Adolf Meyer
141. J. L. Moreno
142. J. L. Moreno
143. J. L. Moreno
144. J. L. Moreno
Sociometry of morale, Amer. Sociolpgic Rev.,
v. S, No. 6, December.
Sociometry in the classroom, in: Sociometry,
v. Ill, No. 1, January.
Objective selection of group leaders, in:
Sociology and Social Research; March.
Experimental appraisal of group learning
plan, Journal of Educational Research, vol.
XXXIV.
Group learning, Social Education, vol. IV,
May.
Psychology and Psychotherapy; Baltimore,
Williams and Wilkins.
The Alcoholic Foundation (publishers),
P.O. Box 658, Church St. Annex, New York,
N. Y.
Developments in social psychology, 1930-
1940, Sociometry Monograph No. 1, Beacon
House, New York.
"A constructive approach to the problems
of childhood and adolescence", Journal of
Criminal Psychopathology, vol. II, No. 3,
January.
See: Moreno, No. 144 of this Bibliogr.
See: No. 135, this Bibliogr.
The theater for psychodrama at St. Eliza-
beth's Hospital, Sociometry, v. IV, No. 2,
May.
See: No. 138, this Bibliogr.
Group catharsis in psychodrama, with spe-
cial emphasis upon the psychopathology of
money; Sociometry, v. IV, No. 2, May.
Spontaneity, Sociometry, v. IV, No. 2, May.
Foundations of sociometry, Sociometry, v.
IV, No. 1, February.
The philosophy of the moment and the spon-
taneity theater, Sociometry, v. IV, No. 2,
May.
The advantages of the sociometric approach
to problems of national defense, Sociometry,
v. IV, No. 4, November.
The prediction and planning of success in
marriage, Marriage and Family Living, vol.
Ill, No. 4, November,
291
530
GROUP PSYCHOTHERAPY
145, J. L. Moreno with
Wm. S. Dunkin
146. Louise Price
146a. Paul Schilder
147. P. L. Smith
148. Bruno Solby
149. Leslie D. Zeleny
150. Ernest W. Burgess
1942
151. Howard Becker with
Ruth Hill Useem
152. Joan H. Criswell
152a. John K. Fischel
153. J. G. Franz
154. Samuel B. Hadden
155. J, Robert Jacobson
156. Helen H. Jennings
157. Helen H. Jennings
158. Leona M. Kerstetter
159. G. A. Lundberg
The function of the social investigator in
experimental psychodrama; Sociometry, v.
IV, No. 4, November.
Creative work on the campus. New York
Bureau of Publications, Teachers College,
Columbia University.
See: Curran, No. 136, this Bibliogr.
"Alcoholics Anonymous"; Psychiat. Quart.,
IS: 554.
The psychodramatic approach to marriage
problems; Amer. Sociolog. Review, vol. 6,
No. 4, August.
Experiments in leadership training; Journ. of
Educational Sociology, January.
An experiment in standardization of the
case-study method; Sociometry, v. IV, No. 4,
November.
Sociologic analysis of the dyad; Amer. Soci-
olog. Rev., v. 7, No. 1, February.
The saturation point as a sociometric con-
cept; Sociometry, vol. V, No. 2.
See: No. 163, this Bibliogr.
The psychodrama and interviewing; Amer.
Sociolog. Rev., v. 7, No. 1, February.
Treatment of the neuroses by class technic;
Ann. Int. Med., 16: 33.
Review of a year of group psychotherapy;
Psychiat. Quart., 16: 744-64. Utica, N. Y.,
State Hospitals Press. ._
Experimental evidence on the social atom
at two time points; Sociometry, v. V, No. 2,
May.
A sociometric study of emotional and social
expansiveness at the adolescent age level; in:
Section on Social Behavior, Child Behavior
and Development (ed.: R. G. Barker, J. S.
Kounin and H. F. Wright), New York,
McGraw Hill Book Co.
The persistence of choice in a class group;
unpublished Master's Thesis; N. Y. Univ.,
New York.
Social research, a study in methods of gath-
ering data; New York, London, Toronto:
Longmans, Green & Co.
292
HISTORICAL SURVEY
531
160. Maxwell Jones
161. M. Moore
162. J. L. Moreno
163. J. L. Moreno with
John K. Fischel
164. J. L. Moreno with
Zerka Toeman
164a. W. Rhoades
165. E. A. Strecker and
K. E. Appel
166. Fritz Redl
167. Zerka Toeman
167a. Ruth Hill Useem
167b. Katharine W. Wright
1943
168. Nathan W. Ackerman
168a. K. E. Appel
169. Joshua Bierer
170. W. R. Km and
J. Rickman
171. Donald Blair
172. Rose Cologne
173. Samuel B. Hadden
174. A. Hauptmnn
175. J. L. Hamilton
176. Paul Komora
Group Psychotherapy (experiences with a
group of 50 soldiers); Brit. Med. J., 1942,
p. 276.
The practice of psychiatry, Harvard Medic.
Alumni Bull., 16: 53.
Foundation of the sociometric institute,
Sociometry, v. V, No. 2, May.
Spontaneity procedures in television broad-
casting, emphasis on therapeutic film, Soci-
ometry, v. V, No. 2, May.
The group approach in psychodrama, Soci-
ometry, v. V, No. 2, May.
The adventure of living; Lippincott, Phila-
delphia, 1942.
Psychiatry-society-survival, Amer. Jnl. Eco-
nomics & Sociology I, 2: 193.
Group emotion and leadership, Psychiatry,
vol. V.
See No. 164, this Bibliogr.
See No. 151, this Bibliogr.
See No. 155, this Bibliogr.
Group therapy from the point of view of the
psychiatrist, Amer. Jnl. Orthopsychiatry, vol.
XIII, 678.
See: No. 84, this Bibliogr.
A new form of group psychotherapy, Pro-
ceedings, R. Soc. of Med., London, Dec. 14.
Intragroup tensions in therapy, their study
as a task of the group, Lancet (London) 2:
678.
Group psychotherapy for war neuroses,
Lancet (London) p. 204.
Experimentation in a self-help community
center; Sociometry, vol. VI, No. 3, August.
Group psychotherapy, Transact. Amer.
Neurol. Assoc., vol. 69, p. 132, ff (with dis-
cussion).
Group psychotherapy for psychoneuroses,
Diseas. Nerv. System, January, p. 22.
Psychodrama and its implications in speech
adjustment; Quart. Jrnl. Speech, 29: 61-67,
February 1943.
Rehabilitation of mentally wounded soldiers,
111. Publ. Welf. Bull., April (1943) p. 4.
293
532
GROUP PSYCHOTHERAPY
177. Lawrence S. Kubie
178. Abraham Low
179. Jacob L. Moreno
180. A. L. Perkins
180a. J. Rickman
181. Maria Rogers
182. Howard P. Rome
183. Stephen Sherman
184. E. A. Strecker and
K. E. Appel
IBS. Giles W. Thomas
1944
186. P. L. Axelrod,
M. S. Cameron and
J. C. Salomon
187. R. R. Cohen
188. Paul Cornyetz and
John Del Torto
189. E. Durkin,
H. T, Glatzer
and L S. Hirsch
190. B. Gabriel
190a. M. J. Farrel
191. Roy R. Grmker
and J. P. Spiegel
192. John del Torto
and Paul Cornyetz
193. S. B. Hadden
The nature of psychotherapy; Bull., N. Y.
Acad. of Med,, voL 19: 183.
The techniques of self-help in psychiatric
after-care, Recovery Inc., Chicago.
Sociometry and the cultural order, Sociome-
try Monograph No. 2, Beacon House, N. Y.
Psychotherapeutic aspects of state hospital
psychiatry, 111. Med. Journ., 83: 398.
See: No, 170, this Bibliogr.
Sociometry and adult education, Sociometry,
vol. 6, No. 3, August.
See Discussion to S. B. Hadden, No. 173,
this Bibliogr.
System of combined individual and group
therapy as used in medical program for mer-
chant seamen, Amer. Journ. Psychiat., 100:
127.
Psychiatry and modern warfare, Macmillan,
New York.
Group Psychotherapy, A review of the recent
literature; Psychosomatic Med., 5, No. 2,
pg. 166-180, 3 tabl., April 1943.
Group psychotherapy: experiment with shy
adolescent girls, Am. J. Orthopsychiat., vol.
14: 616.^
Factors in adjusting to Army life, plan for
preventative psychiatry by mass psycho-
therapy; War Med., vol. S: 83.
Psychodrama as expressive and projective
technique; Psychodrama Monograph No. 14,
Beacon House, New York.
Therapy of mothers 'in groups, Amer. Jnl.
Orthopsych., vol. 14: 68.
Group treatment for adolescent girls, Amer.
J. Orthopsychiat, vol. 14: 593.
Developments in Milit. Neuropsychiatry;
Iowa Med. Assodat. Jouiu, September.
"Narcosynthesis"; in: Air Surgeon's Bulletin
No. 2, February 1944, pg. 1-5.
How to organize a psychodramatic unit,
Sociometry, vol. VII, No. 2.
Group psychotherapy superior method of
treating larger number of neurotic patients;
Amer. J. Psychiat, 101: 68-72, July.
294
HISTORICAL SURVEY
533
194. F. Hamilton
195. Charles E. Eendry
196. J. W. Klapman
197. Edwin Lemert and
Charles Van Riper
198. Joseph I. Meiers
198a. Florence Moreno
199. J. L. Moreno and
Florence B. Moreno
200. J. L. Moreno
200a. S. Paster
201. Howard P. Rome
202. H, Ross
203. Theodore R. Sarbin
204. D. A. Shaskan '
and M. Jolesh
205. Nahum Shaobs
206. S. R. Slavson
207. Bruno Solby
208. J. C. Solomon and
P. Axelrod
208a. Harry C. Solomon
Group psychotherapy in military medicine;
Northwestern Medicine, vol. 43: 247.
Role practice brings the community into the
classroom; Sociometry, v. VIE, p. 196.
Group psychotherapy impressions, Psycho-
analytic Rev., vol. 31: 322.
The use of psychodrama in the treatment of
speech defects; Sociometry, v. VII, 190-96.
Informal "One-patient Talks before the
Group" with discussion as group-psycho-
therap. measure (unpubl. material, 1944).
See: No. 199 this Bibliogr.
Spontaneity theory of child development;
Sociometry, v. VII, 89428; (re-publish.);
Psychodrama Monograph, No, 8, Beacon
House, N. Y., 48 pg., 4 fig.
Psychodrama and therapeutic motion pic-
tures; Sociometry, v. VII, pg. 23044;
Psydiodrama Monograph, No. 14.
Group psychotherapy in an Army general
hospital; Mental Hygiene, vol. 28: 529.
Group psychotherapy, chapter in: Manual
of milit. neuropsychiatry, ed. by H. C.
Solomon and P. L Yakovlev; Philadelphia
and London, W. B. Saunders, 1944, 764 pp.
See spec.: pg. 562.
Group psychotherapy related to group trau-
ma, Am. Jnl. Orthopsychiat., vol. 14: 609.
The concept of role-taking; Sociometry,
vol. VI.
Group psychotherapy and war, Am. Jnl.
Orthopsychiat., vol. 14: 571.
Psychodrama in the schools; Sociometry,
vol. VII, 152-68; (republish.) : Psychodrama
Monograph, No. 10.
Group psychotherapy of Jewish Bd. of
Guards., Mental Hygiene, vol. 28: 414.
The role concept in job adjustment; Soci-
ometry, v, VII, 222-29.
Group therapy of withdrawn adolescents,
Am. Jnl. Dis. Chil., vol. 68: 86.
See H. P. Rome, No. 201, this Bibliogr.
295
534
GROUP PSYCHOTHERAPY
209. Zerka Toeman
210. Mary B. Treudley
21 L Abraham L. Umansky
212. U. S. War Department
Technical Bulletin
(TB, Med. 28)
213. War Psychiatry
Role analysis and audience structure with
special emphasis on problems of military
adjustment; Psychodrama Monograph No.
12, Beacon House, N. Y., 1944, 19 pg.,
5 tables.
Psychodrama and social case work; Sociom-
etry, v. VII, 169-178.
Psychodrama and the Audience; in: Sociome-
try, v. VII, No. 2, May, p. 179-189.
Treatment program for psychiatric patients.
214. Alvin Zander,
Ronald Lippitt
and Chas, E. Hendry
215. Ernst Zierer
1939
216. Huizinga
1944
217. Wffliam Malamud
Published under the ausp. of the Institute
for Psychoanalysis, Chicago, 1944, 55 pg.
(Papers read at the Second Brief Psycho-
therapy Council, Chicago, January 1944.)
Reality, practice as educational method;
Sociometry, v. VII, p. 129-151.
Creative therapy and diagnosis (personal
communication, 1944). A new psychother.
method, with emphasis on integration and
color tension evaluation. To be published,
in collaboration with L Silbermann, M.D.
ADDENDA
Homo Ludens (Man the Player), Amsterdam.
The history of psychiatric therapies, in One
Hundred Years of American Psychiatry.
New York, 1944, p. (273)-323, American
Psych'iat. Association, N. Y.
296
THE FUTURE OF MAN'S WORLD
J. L. MORENO
Sociometric Institute, New York City
The new outlook in psychiatry was perhaps most dramatically heralded
in the single opening sentence of my best known opus: "A truly therapeutic
procedure cannot have less an objective than the whole of mankind" and
as if to indicate that the fate of mankind may be, imminently at stake, I
gave the book the title, "Who Shall Survive."
As my idea of group psychotherapy has meanwhile taken historical
proportions, it may be of more than human interest to report here the
anecdotal background of this title. The first title was "Sociometry,"
but the late Dr. William A. White, who had written the Foreword to it
in the summer of 1933, thought "Sociometry" a bit too technical and sug-
gested "Human Interrelations." On second thought I felt that neither "Soci-
ometry nor "Human Interrelations" expressed the core of the book, gave in to
a brainwave and called it "Who Shall Survive" with the undertitle "A New
Approach to the Problem of Human Interrelations." There has hardly been a
review of the book which has not contained a derogatory remark about this
title. Sociologists thought 'it funny for a sociological treatise. Psychia-
trists found it strange for a contribution to psychiatry. Biologists said the
title was biological, but it was not a biological book. Twelve years have
gone by but the discussion concerning the title is not yet closed. In a uni-
versity seminar a student made the remark that after careful reading, the
title made sense: "It means that everyone shall survive, there is a place and
an opportunity for all." A few weeks ago I received a letter from a dis-
tinguished psychiatrist saying: "The more time goes by the more the title
'Who Shall Survive' seems to reflect the basic situation of our age."
Broadly viewed, "Who Shall Survive" deals with two social issues, the
relation of man to man and the relation of man to certain peculiar products
of his mind, which when separated from him, can function independently.
It boils down to an appraisal of the positive forces which man has at his
command to meet two threats, the aggression coming from man and the
aggression coming from "robots."* The answer to the first was sodometry.
The answer to the second was creative revolution, based on a theory of
*Robot derives from a Polish word robota, to work. My idea of the zootechnical
animal (1918) was popularized a few years later by Karl Czapek in a play "Rossom's
Universal Robots", 1921; he coined the term robot. But the term is not adequate as in
297
535
536 GROUP PSYCHOTHERAPY
spontaneity. However, both have to work hand in hand in order that either
should be effective.
The surface connotations in the title "the survival of the fittest/'
with the added implications of racial arrogance have been over-stressed.
The deeper connotations, the survival of human existence itself (not only of
the fit; 1 fit and unfit are now in the same boat), of human creativity, of
man's universe, have been overlooked. These enemies are common to all
men, not only to one or another group; they are threats to the survival
of the total universe of men. These odd enemies are technical animals which
can be divided into two classes, cultural conserves and machines. The more
popular word for them is "robots."* One of my earliest writings 2 was an
expose to their systematic study; I proposed a new science, "Die Zootechnik,
Wissenschaft von den technischen Tieren," i.e., Zootechnique, Science of the
Technical Animals. I put the analysis of the book into the foreground
as a robot par excellence, referring to other types of robots which man
has invented, such as the plow, cannon, money, and airplane. It dis-
cussed the two functions and relations of the robot towards man, as his
friend and helper and as his enemy and destroyer. I gave particular em-
phasis to the apocalyptic character of the enemy robot, and painted a
sinister picture of what the fate of man's world would be if no controls
are developed against some of their vicious forms. "The parthogenetically
procreated offspring exterminates the parent." "It is the threat of a world to
come, completely mechanized, from which all cosmic remnants have per-
ished. 73
The racial revolution and World War Number 2 have divided man-
kind into several camps, one fighting the other. But the invention of the
atomic bomb has given us an excellent didactic lesson of how foolish inter-
human wars are and how unstable and unsafe is the basis of all human
the zootechnical animal not only work but also destruction is implied. Thus in my
definition the working robot can become ferocious and vice versa. A better term than
robot might have been genie. According to the Arabic use there were good and bad
spirits among them who assumed the form of animals, giants and so forth. The robot
is really a "zoomaton," zoo, from Greek zoon, animal (zoo, live), automaton, a Greek
word, neut. Of automates, autos, self plus mao, strive after.
Tit and unfit, Darwin's survival of the fittest, have become increasingly "psy-
chagogic" terms.
^Quotations are translated from Die Gottheit als Autor (The Godhead as
Author, in Daimon, February, 1918, p. 7). See also Der Koenigsroman, 1923,
298
FUTURE OF MAN'S WORLD 537
existence. We need one another but continue to fight each other. An
enemy has appeared on the horizon which is an enemy to all men, which may
make an end to all races, superior and inferior, fit or unfit, old and new. It
is as if mankind has been awakened from a dream in which it indulged in
the chronic and comparatively innocent war plays of its pre-bomb era.
Shaken, it finds itself face to face with a reality of the present and of the
future, the atomic bomb and its kins to come, unhuman but not unreal, un-
living but not uncosmic. The answer to this great emergency (which has
been anticipated in smaller doses in the course of human evolution and of
which the invention of the fire, of the tool and of the book are outstanding
examples) does not lie in palliative measures like counter-robots, an inter-
national police or a world society (which are, of course, fine things to aim
at). The countermeasure lies in a cold appraisal of the situation, a systematic
study of the causations underlying the invention of mechanical devices,
the origin of the robot in human nature and beyond it, a careful calcula-
tion of the "socio-atomic organization of mankind." In other words, we
should bring the problem Into full scientific consciousness and develop
parallel with sociometry a zootechnique, a science of the technical animals.
The invention of robots is largely a skill of homo sapiens. The reason
for their origination is mysterious; perhaps "when man found himself failing
in his struggle for maximum creativity he divided from his will to create
his will to power" 3 and now his will to have power turns against his will
to create. Why should man want robots? It is perhaps the same reason,
in reverse, as the one which at an earlier period made us want a God to
whom we were robots. Therefore, if we could understand what we mean
to God, we could understand what robots mean to us. Our relationship to
God may be simply thjk he needs a lot of helpers in order to put his crea-
tion over. Man too, has a program of living, of creation on a minor scale,
he needs helpers and weapons to defend himself against enemies. But all
animals do that without robots, they just multiply themselves. The bio-
logical robots of animal reproduction do not satisfy us men "entirely." There
must be a deeper and additional reason why we wanted and created the
technological kind. An analysis of spontaneous-creative processes broad-
ened my understanding of the problem. Infants, immediately after birth
demonstrate that the less spontaneity a being has the more it requires some-
*See J. L. Moreno's Commentary to Hie Words of the Father, Beacon House, New
York, 1942, p. 181.
299
538 GROUP PSYCHOTHERAPY
one who has it, in order to survive. The infant lives on borrowed spon-
taneity. The humans who are at the beck and call of the crying infant,
who come and carry, feed and comfort it, I call auxiliary egos. By auxiliary
ego I do not mean the total person of the mother or father, for instance,
but the "role" it has for the infant. Everything, however, which is outside
of that role, frightens the child. An excess of spontaneity which that per-
son turns upon the infant beyond or outside of the role appears to be an
irritating factor. The infant seems to want its auxiliary egos perfect, that
is, to have all their ready spontaneity available for him, the infant, and none
for themselves, the egos. This offers a clue for understanding the relation-
ship between the idea of the auxiliary ego and the idea of the robot. If
the auxiliary ego could concentrate and conserve all its spontaneity for one
function, the role which satisfies the needs of the infant would not permit
any diversion of spontaneity for himself. He would be less real and human,
but a more perfect auxiliary ego* These observations were confirmed by
the attitude which children show towards dolls. The doll does not have the
often unpleasant counter-spontaneity which real human beings have, but it
has still some physical and tangible reality which pure fantasy companions
do not have. In the half real, half mechanical doll world the child can act
as an unhibited ruler. Here he gets the first taste of the robot which he
can destroy at will and which may one day go out and act as decreed by
him. Dolls seem to make the child free free from other children and
from adults. One can divide the doll robots as fulfilling two functions: the
doll which represents a companion and friend, a mechanical role-player,
a domesticated automaton; and then the doll as the object of unlimited ag-
gression, the mechanical role-player who is fought and killed without having
a defense, an enemy automaton. I have described elsewhere 4 how play-
ing and long preoccupation with dolls encourages the child to treat animals
and human beings like robots. In psychodramatic procedure we are using
the auxiliary ego to do this consciously and systematically. The auxiliary
ego sacrifices his own ego and produces roles in accord with the require-
ments of the patient. He extends the universe of the patient so that the pa-
tient can find new situations and new associates. The robot, like the auxiliary
*See Towards the Curriculum of an Impromptu Play School, Impromptu Maga-
zine, No. 2, 1931, Beacon House, New York. Also Sociometry and the Cultural Order,
Sociometry Monograph No. 2, Beacon House, New York, 1943, and Das Stegreiftheater,
1923.
300
FUTURE OF MAN'S WORLD 539
ego, makes man free from man and gives him an artificial sense of wellbeing
and power. It too, extends the range of megalomania experience to a new
climax. But that is the limit of the similarities between the two. Behind
the role-giving auxiliary ego is a warm, spontaneous being. The robot is life-
less. It is the same at every instant, it does not grow, it does not change. Once
upon a time we envisoned our God as the one who could destroy us any
time he wanted to. Robots, too, can give a single man the power to rule
and perhaps to destroy the universe instantly. But they cannot produce
an ounce of spontaneity.
A human infant results from the conjugation of a man and a woman.
A robot results from the conjugation of man with nature itself. In both
cases the offspring takes over some feature from both parents. In the robot,
for instance, there is some feature of the man-producer and some feature of
natural energy modified by him.
A descriptive classification of the various types of robots man has
invented should precede their dynamic analysis. One type can be defined
as the domesticated robot, the plow, the pen, the book, the type-writer;
another type can be defined as the enemy robot, the gun, the rocket, the
atomic bomb. Then there is the mixed form of robot, as a knife, a fire,
steam engine, the automobile and the airplane, which can be used for and
against himself. But because of the non-human character of the robot it
can easily be turned from one function into another, the automobile can
be turned into a wartank, a working knife can be turned into a weapon,
the warming fire turned into a means for destruction. Many of the domesti-
cated robots are blessed with the attribute of becoming labor-saving de-
vices, which has, however, the unpleasant consequence that they at times
reduce the need for creating, promoting with leisure also inertia. Robots
are more precise and reliable than animals and human beings. Many of the
robots have also the attribute in common of being able to affect human
beings or other targets "at a distance/' a book, a radio or a television
sender can entertain or teach at a distance, like a gun, a rocket and an
atomic bomb can kill people and destroy objects at a distance. The book
is a robot par excellence. Once off the press, the parent, the producer, the
author is immaterial, the book goes to all places and to all people, it does
not care where it is read and by whom. Many robots have further in
common the attribute of comparative immortality. A book, a film, an
atomic bomb, they do not perish in the human sense, the same capacity is
301
540 GROUP PSYCHOTHERAPY
always there, they can be reproduced ad infinitim. A book may have to
be reprinted, a film copied on and off, but, if anything perishes it is not
their essence but some material entourage. Our human world is increas-
ingly filled with robots and there seems to be no end to new forms and new
developments. Since man came out of the jungle, its master, he did not
have a similar maze of threats to face the jungle of robots.
The control of the robot is complicated for two reasons, the one reason
is that the robot is man's own creation. He does not meet it face to face,
like he did the beasts of the jungle, measuring his strength, intelligence
and spontaneity with theirs. The robot comes from within his mind, he
gives birth to it. He is confounded like every parent is towards his own
child. Rational and irrational factors are mixed therefore in his relation-
ship to robots. In the excitement of creating them he is unaware of the
poison which they carry, threatening to kill his own parent. The
second reason is that in using robots and zoomatons man unleashes
forms of energy and perhaps touches on properties which far surpass his
own little world and which belong to the larger, unexplored and perhaps
uncontrollable universe. His task of becoming a master on such a scale
becomes a dubious one as he may well find himself more and more in the
position of Goethe's Sorcerer's Apprentice who could unleash the robots
but who could not stop them. The apprentice had forgotten the master's
formula, we never had it. We have to learn this formula and I believe it
can be learned.
The fate of man threatens to become that of the dinosaur in reverse.
The dinosaur perished because he extended the power of his organism in excess
of its usefulness. Man may perish because of reducing the power of his
organism by fabricating robots in excess of his control.
The conclusion is that as parents and creative agents we produce more
perfect robots than we produce babies. As our perfectionism has failed
us again and again in its application to us as biological and social beings,
as individuals and as' a society of individuals, we give up hope and invest it
in automatons. The pathological consequences are enormous. Man turns
more and more into a function of cultural and technological conserves, puts
a premium on power and efficiency^ and loses credence in spontaneity and
creativity. The two countermeasures suggested are the sociometric approach
to group relations and spontaneity training.
The use of physical atom energy can be directed and controlled by
302
FUTURE OF MAN'S WORLD 541
"social atom energy." 5 Man has never recognized and used in full the
power pent up in the millions of social atoms continuously formed by him
and his fellowmen. If he would, robots like the atomic bomb would be
to a "sociometrically integrated mankind" what a doll is in the hands of
a child. "If a fraction of one-thousandth of the energy which mankind has ex-
erted in the conception and development of mechanical devices were to be
used for the improvement of our cultural capadty during the moment of
creation itself, mankind would enter into a new age of culture, a type of
culture which would not have to dread any possible increase of machinery
nor robot races of the future. The escape would be made without giving
up anything that machine civilization has produced. 6
EPILOGUE
A system of society must be realized, to which all individuals belong
spontaneously, not only "by consent" but as "initiators"; without excep-
tion, not 99.9 per cent, but literally and numerically all individuals aim.
The "one" individual left out may turn out to become the singular scientist-
criminal using means of lethal destruction, not towards one or another fellow
man (Cain vs. Abel) but towards the total race of man, his total world.
Man must take his own fate and the fate of the universe in hand, on the
level^of creativity, as a creator. It is not sufficient if he tries to meet the situa-
tion by technical control defense weapons nor by political controls world
government he should face himself and his society in statv nascendi and
learn how to control the robot not after it is delivered, but before it is
conceived (creatocracy).
I have often described the revolutionary period during the last hundred
and fifty years in terms of three phases: the economic, the psychological
and the creative revolution. In economic ideology the robot was greeted
as a benevolent, labor saving and comfort bringing agent. It made the poor
and the rich the owners of technical slaves. To some it seemed tp hold
promise of solving the class conflict* In the ideology of the psychological
revolution at least in its most recent demoniac form, using racial and
political phraseology to cover up psychological causations the robot be-
came an agent of destruction. The number of men could be reduced without
loss, now that the kind and number of robots could be multiplied without
5 Who Shall Survive, pp. 141-157.
*Who Shall Survive, pp. 364-65; also "Creative Revolution," p. in Impromptu,
(1931),
303
542 GROUP PSYCHOTHERAPY
limit. In the ideology of creative revolution the robot is finally seen in
relation to the creative act itself.
Could we imagine a congress appropriating two billion dollars for
"social atom" research? Maybe it is not and will not be appropriated
because what matters is not money; Mankind may need still more serious
setbacks before it comes to its "creative revolution." Perhaps it is un-
avoidable that the present human civilization be destroyed, that mankind
be reduced to a handful of individuals and human society to a few scat-
tered social atoms before a new rooting can begin. Christianity too, has
not been helped by mass baptism of babies; fewer but self-realized Chris-
tians might have meant more true Christianity.
The battle between zoon (living animal) and zoomaton approaches a
new peripetie. The future of man depends upon counterweapons developed
by sociometry and group psychotherapy.
304
SUBJECT'S INDEX
Audience, 56, 78-79, 145, 148, 161-170, 218-225, 255-259
Auxiliary ego, 79, 114, 126, 147-148, 162-164, 223, 300-301,
Catharsis, mental, 128-129, 186
action, 129
spectator, 128
group, 169
Chance, deviation from, 82-84
Contra-indication, 84
Control study, grouping and regrouping, 82
Dance, 243-245
Group psychotherapy, origin of term, 13, 128, 261-264
definition, 19, 27, 34-37, 50, 77, 108, 118, 264
categories, 80-81, 268-269
methods, 85, 101, 125, 161, 205, 227, 243, 247
military, 45, 73, 205, 247
validity, 82-83
Group therapy, 50, 268
Motion picture, 48, 247-253, 255-260
Psychoanalysis, 25-26, 31-32, 77, 103, 108-109, 122, 264
Ps^chodrama, *3; 43, S2-53;V4-5J7,, 58-67, 125-45, 265-266
Psychomusic, 238-242
Robot, 297-300
Role, 188-203
Sociatry, 78, 205
Sociodrama, 161-170, 255-259
Sociometry, 131, 213-214
Sociosis, 78, 164, 169
Tele, 79
Transference, 78, 127
Warming up process, 218-225
Zooniaton, 298, 304
Zootechnique, 298
305
543
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